WorldWideScience

Sample records for virtual international stroke

  1. Effects of virtual reality for stroke individuals based on the International Classification of Functioning and Health: a systematic review.

    Science.gov (United States)

    Palma, Gisele Carla Dos Santos; Freitas, Tatiana Beline; Bonuzzi, Giordano Márcio Gatinho; Soares, Marcos Antonio Arlindo; Leite, Paulo Henrique Wong; Mazzini, Natália Araújo; Almeida, Murilo Ruas Groschitz; Pompeu, José Eduardo; Torriani-Pasin, Camila

    2017-05-01

    This review determines the effects of virtual reality interventions for stroke subjects based on the International Classification of Functioning, Disability,and Health (ICF) framework. Virtual reality is a promising tool for therapy for stroke rehabilitation, but the effects of virtual reality interventions on post-stroke patients based on the specific ICF domains (Body Structures, Body Functions, Activity, and Participation) have not been investigated. A systematic review was conducted, including trials with adults with a clinical diagnosis of a chronic, subacute, or acute stroke. Eligible trials had to include studies with an intervention protocol and follow-up, with a focus on upper limbs and/or lower limbs and/or balance. The Physiotherapy Evidence Database (PEDro) was used to assess the methodological quality of randomized controlled trials. Each trial was separated according to methodological quality into a high-quality trial (PEDro ≥ 6) and a low-quality trial (PEDro ≤ 6). Only high-quality trials were analyzed specifically based on the outcome of these trials. In total, 54 trials involving 1811 participants were included. Of the papers included and considered high quality, 14 trials evaluated areas of the Body Structures component, 20 trials of the Body Functions domain, 17 trials of the Activity component, and 8 trials of the Participation domain. In relation to ICF Part 2, four trials evaluated areas of the Personal Factors component and one trial evaluated domains of the Environmental Factors component. The effects of virtual reality on stroke rehabilitation based on the ICF framework are positive in Body Function and Body Structure. However, the results in the domains Activity and Participation are inconclusive. More high-quality clinical trials are needed to confirm the effectiveness of virtual reality in the domains of Activity and Participation.

  2. Virtual reality for stroke rehabilitation.

    Science.gov (United States)

    Laver, Kate E; Lange, Belinda; George, Stacey; Deutsch, Judith E; Saposnik, Gustavo; Crotty, Maria

    2017-11-20

    Virtual reality and interactive video gaming have emerged as recent treatment approaches in stroke rehabilitation with commercial gaming consoles in particular, being rapidly adopted in clinical settings. This is an update of a Cochrane Review published first in 2011 and then again in 2015. Primary objective: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity.Secondary objectives: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on: gait and balance, global motor function, cognitive function, activity limitation, participation restriction, quality of life, and adverse events. We searched the Cochrane Stroke Group Trials Register (April 2017), CENTRAL, MEDLINE, Embase, and seven additional databases. We also searched trials registries and reference lists. Randomised and quasi-randomised trials of virtual reality ("an advanced form of human-computer interface that allows the user to 'interact' with and become 'immersed' in a computer-generated environment in a naturalistic fashion") in adults after stroke. The primary outcome of interest was upper limb function and activity. Secondary outcomes included gait and balance and global motor function. Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data, and assessed risk of bias. A third review author moderated disagreements when required. The review authors contacted investigators to obtain missing information. We included 72 trials that involved 2470 participants. This review includes 35 new studies in addition to the studies included in the previous version of this review. Study sample sizes were generally small and interventions varied in terms of both the goals of treatment and the virtual reality devices used. The risk of bias present in many studies was unclear due to poor reporting. Thus, while there are a large

  3. Virtual reality for stroke rehabilitation.

    Science.gov (United States)

    Laver, Kate E; George, Stacey; Thomas, Susie; Deutsch, Judith E; Crotty, Maria

    2011-09-07

    Virtual reality and interactive video gaming have emerged as new treatment approaches in stroke rehabilitation. In particular, commercial gaming consoles are being rapidly adopted in clinical settings; however, there is currently little information about their effectiveness. To evaluate the effects of virtual reality and interactive video gaming on upper limb, lower limb and global motor function after stroke. We searched the Cochrane Stroke Group Trials Register (March 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 1), MEDLINE (1950 to March 2010), EMBASE (1980 to March 2010) and seven additional databases. We also searched trials registries, conference proceedings, reference lists and contacted key researchers in the area and virtual reality equipment manufacturers. Randomised and quasi-randomised trials of virtual reality ('an advanced form of human-computer interface that allows the user to 'interact' with and become 'immersed' in a computer-generated environment in a naturalistic fashion') in adults after stroke. The primary outcomes of interest were: upper limb function and activity, gait and balance function and activity and global motor function. Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data and assessed risk of bias. A third review author moderated disagreements when required. The authors contacted all investigators to obtain missing information. We included 19 trials which involved 565 participants. Study sample sizes were generally small and interventions and outcome measures varied, limiting the ability to which studies could be compared. Intervention approaches in the included studies were predominantly designed to improve motor function rather than cognitive function or activity performance. The majority of participants were relatively young and more than one year post stroke. results were statistically significant for arm function (standardised

  4. Cochrane review: virtual reality for stroke rehabilitation.

    Science.gov (United States)

    Laver, K; George, S; Thomas, S; Deutsch, J E; Crotty, M

    2012-09-01

    Virtual reality and interactive video gaming are innovative therapy approaches in the field of stroke rehabilitation. The primary objective of this review was to determine the effectiveness of virtual reality on motor function after stroke. The impact on secondary outcomes including activities of daily living was also assessed. Randomised and quasi-randomised controlled trials that compared virtual reality with an alternative or no intervention were included in the review. The authors searched the Cochrane Stroke Group Trials Register, the Cochrane Central Register of Controlled Trials, electronic databases, trial registers, reference lists, Dissertation Abstracts, conference proceedings and contacted key researchers and virtual reality manufacturers. Search results were independently examined by two review authors to identify studies meeting the inclusion criteria. Nineteen studies with a total of 565 participants were included in the review. Variation in intervention approaches and outcome data collected limited the extent to which studies could be compared. Virtual reality was found to be significantly more effective than conventional therapy in improving upper limb function (standardised mean difference, SMD) 0.53, 95% confidence intervals [CI] 0.25 to 0.81)) based on seven studies, and activities of daily living (ADL) function (SMD 0.81, 95% CI 0.39 to 1.22) based on three studies. No statistically significant effects were found for grip strength (based on two studies) or gait speed (based on three studies). Virtual reality appears to be a promising approach however, further studies are required to confirm these findings.

  5. Virtual reality in rehabilitation after stroke

    Directory of Open Access Journals (Sweden)

    Krasnova-Goleva V.V.

    2016-01-01

    Full Text Available After a stroke many people have serious problems in motion activity, decline in cognitive activity, as well as a number of psychological problems that may accompany the man for many years. Motivational rehabilitation component plays a decisive role in the process of recovery after suffering a stroke. At present one of the most successful methods of rehabilitation is considered to be a recovery through "observation-imitation”, because this method enhances the plasticity of the brain and, as a result, rehabilitation potential. Modern rehabilitation using virtual reality had demonstrated good results to improve motor and cognitive skills, as well as the psychological condition

  6. Virtual reality in stroke rehabilitation: still more virtual than real.

    Science.gov (United States)

    Crosbie, J H; Lennon, S; Basford, J R; McDonough, S M

    2007-07-30

    To assess the utility of virtual reality (VR) in stroke rehabilitation. The Medline, Proquest, AMED, CINAHL, EMBASE and PsychInfo databases were electronically searched from inception/1980 to February 2005, using the keywords: Virtual reality, rehabilitation, stroke, physiotherapy/physical therapy and hemiplegia. Articles that met the study's inclusion criteria were required to: (i) be published in an English language peer reviewed journal, (ii) involve the use of VR in a stroke rehabilitation setting; and (iii) report impairment and/or activity oriented outcome measures. Two assessors independently assessed each study's quality using the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) grading system. Eleven papers met the inclusion criteria: Five addressed upper limb rehabilitation, three gait and balance, two cognitive interventions, and one both upper and lower limb rehabilitation. Three were judged to be AACPDM Level I/Weak, two Level III/Weak, three Level IV/Weak and three Level V quality of evidence. All articles involved before and after interventions; three randomized controlled trials obtained statistical significance, the remaining eight studies found VR-based therapy to be beneficial. None of the studies reported any significant adverse effects. VR is a potentially exciting and safe tool for stroke rehabilitation but its evidence base is too limited by design and power issues to permit a definitive assessment of its value. Thus, while the findings of this review are generally positive, the level of evidence is still weak to moderate, in terms of research quality. Further study in the form of rigorous controlled studies is warranted.

  7. Effect of Virtual Reality on Cognition in Stroke Patients

    OpenAIRE

    Kim, Bo Ryun; Chun, Min Ho; Kim, Lee Suk; Park, Ji Young

    2011-01-01

    Objective To investigate the effect of virtual reality on the recovery of cognitive impairment in stroke patients. Method Twenty-eight patients (11 males and 17 females, mean age 64.2) with cognitive impairment following stroke were recruited for this study. All patients were randomly assigned to one of two groups, the virtual reality (VR) group (n=15) or the control group (n=13). The VR group received both virtual reality training and computer-based cognitive rehabilitation, whereas the cont...

  8. Integrating eye tracking in virtual reality for stroke rehabilitation

    OpenAIRE

    Alves, Júlio Miguel Gomes Rebelo

    2014-01-01

    This thesis reports on research done for the integration of eye tracking technology into virtual reality environments, with the goal of using it in rehabilitation of patients who suffered from stroke. For the last few years, eye tracking has been a focus on medical research, used as an assistive tool  to help people with disabilities interact with new technologies  and as an assessment tool  to track the eye gaze during computer interactions. However, tracking more complex gaze behavio...

  9. Virtual Reality Training for Upper Extremity in Subacute Stroke (VIRTUES)

    DEFF Research Database (Denmark)

    Brunner, Iris; Skouen, Jan Sture; Hofstad, Håkon

    2017-01-01

    Objective: To compare the effectiveness of upper extremity virtual reality rehabilitation training (VR) to time-matched conventional training (CT) in the subacute phase after stroke. Methods: In this randomized, controlled, single-blind phase III multicenter trial, 120 participants with upper...... extremity motor impairment within 12 weeks after stroke were consecutively included at 5 rehabilitation institutions. Participants were randomized to either VR or CT as an adjunct to standard rehabilitation and stratified according to mild to moderate or severe hand paresis, defined as $20 degrees wrist...... were assessed at baseline, after intervention, and at the 3-month follow-up. Results: Mean time from stroke onset for the VR group was 35 (SD 21) days and for the CT group was 34 (SD 19) days. There were no between-group differences for any of the outcome measures. Improvement of upper extremity motor...

  10. International virtual teams engineering global success

    CERN Document Server

    Brewer, P

    2015-01-01

    As a complete guide to international virtual team communication with practical problem-solving strategies, this book is a must read for managers and engineers in all stages of their professional development This book provides essential information for creating and maintaining successful international virtual teams for those who manage, participate in, or train others in international virtual teaming. Based on new studies in engineering communication, this book presents processes and principles that can help managers and engineers establish global virtual teams that work, assess the virtual team climate, and maintain the effectiveness of virtual teams across cultural boundaries. It provides knowledge and tools necessary to understand the variable contexts of global virtual teams, so that organizations are able to respond to inevitable changes in technology and the global marketplace.

  11. Effect of virtual reality on cognition in stroke patients.

    Science.gov (United States)

    Kim, Bo Ryun; Chun, Min Ho; Kim, Lee Suk; Park, Ji Young

    2011-08-01

    To investigate the effect of virtual reality on the recovery of cognitive impairment in stroke patients. Twenty-eight patients (11 males and 17 females, mean age 64.2) with cognitive impairment following stroke were recruited for this study. All patients were randomly assigned to one of two groups, the virtual reality (VR) group (n=15) or the control group (n=13). The VR group received both virtual reality training and computer-based cognitive rehabilitation, whereas the control group received only computer-based cognitive rehabilitation. To measure, activity of daily living cognitive and motor functions, the following assessment tools were used: computerized neuropsychological test and the Tower of London (TOL) test for cognitive function assessment, Korean-Modified Barthel index (K-MBI) for functional status evaluation, and the motricity index (MI) for motor function assessment. All recruited patients underwent these evaluations before rehabilitation and four weeks after rehabilitation. The VR group showed significant improvement in the K-MMSE, visual and auditory continuous performance tests (CPT), forward digit span test (DST), forward and backward visual span tests (VST), visual and verbal learning tests, TOL, K-MBI, and MI scores, while the control group showed significant improvement in the K-MMSE, forward DST, visual and verbal learning tests, trail-making test-type A, TOL, K-MBI, and MI scores after rehabilitation. The changes in the visual CPT and backward VST in the VR group after rehabilitation were significantly higher than those in the control group. Our findings suggest that virtual reality training combined with computer-based cognitive rehabilitation may be of additional benefit for treating cognitive impairment in stroke patients.

  12. [Virtual reality for therapeutic purposes in stroke: A systematic review].

    Science.gov (United States)

    Viñas-Diz, S; Sobrido-Prieto, M

    2016-05-01

    Virtual reality (VR) is used in the field of rehabilitation/physical therapy to improve patients' functional abilities. The last 5 years have yielded numerous publications on the use of VR in patients with neurological disease which aim to establish whether this therapeutic resource contributes to the recovery of motor function. The following databases were reviewed: Cochrane Original, Joanna Briggs Connect, Medline/Pubmed, Cinahl, Scopus, Isi Web of Science, and Sport-Discus. We included articles published in the last 5 years in English and/or Spanish, focusing on using RV to improve motor function in patients with stroke. From this pool, we selected 4 systematic reviews and 21 controlled and/or randomised trials. Most studies focused on increasing motor function in the upper limbs, and/or improving performance of activities of daily living. An additional article examines use of the same technique to increase motor function in the lower limb and/or improve walking and static-dynamic balance. Strong scientific evidence supports the beneficial effects of VR on upper limb motor recovery in stroke patients. Further studies are needed to fully determine which changes are generated in cortical reorganisation, what type of VR system is the most appropriate, whether benefits are maintained in the long term, and which frequencies and intensities of treatment are the most suitable. Copyright © 2015 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  13. Effects of virtual reality training on mobility and physical function in stroke.

    Science.gov (United States)

    Malik, Arshad Nawaz; Masood, Tahir

    2017-10-01

    Stroke is a common disabling condition which declines the functional and mobility level. The purpose of the case series was to determine the effect of virtual reality training on sensorimotor function and mobility level in stroke patients. Ten male (40-60 year) patients of stroke (08 Infarction, 02 Haemorrhagic) were selected from Physiotherapy department of Pakistan Railway Hospital, Rawalpindi. The additional virtual reality training (15-20 minutes) was provided 03 days per week for 06weeks along with task oriented training. All patients were assessed through Fugl-Meyer Assessment-Lower Extremity (FMA-LE) and Timed Get Up and Go Test (TUG) at baseline and after 06 weeks of training. The results showed that there was significant improvement in mobility level of stroke patients. It is concluded that combination of task oriented and virtual reality training considerably improves the physical performance and mobility level in stroke patients.

  14. Application progress of virtual reality rehabilitation technology in upper limb dysfunction after stroke

    Directory of Open Access Journals (Sweden)

    Bing-jie LI

    2017-07-01

    Full Text Available  Virtual reality (VR rehabilitation technology is a kind of integrated technology which simulates the real world via computer. It has three characteristics: immersion, interaction and imagination. It is widely used in the field of stroke rehabilitation. This review briefly describes the application of virtual reality rehabilitation technology in upper limb dysfunction after stroke. DOI: 10.3969/j.issn.1672-6731.2017.04.002

  15. Data standards for the international virtual observatory

    Directory of Open Access Journals (Sweden)

    R J Hanisch

    2006-11-01

    Full Text Available A primary goal of the International Virtual Observatory Alliance, which brings together Virtual Observatory Projects from 16 national and international development projects, is to develop, evaluate, test, and agree upon standards for astronomical data formatting, data discovery, and data delivery. In the three years that the IVOA has been in existence, substantial progress has been made on standards for tabular data, imaging data, spectroscopic data, and large-scale databases and on managing the metadata that describe data collections and data access services. In this paper, I describe how the IVOA operates and give my views as to why such a broadly based international collaboration has been able to make such rapid progress.

  16. The Effect of Virtual Reality Training on Unilateral Spatial Neglect in Stroke Patients

    OpenAIRE

    Kim, Yong Mi; Chun, Min Ho; Yun, Gi Jeong; Song, Young Jin; Young, Han Eun

    2011-01-01

    Objective To investigate the effect of virtual reality training on unilateral spatial neglect in stroke patients. Method Twenty-four stroke patients (14 males and 10 females, mean age=64.7) who had unilateral spatial neglect as a result of right hemisphere stroke were recruited. All patients were randomly assigned to either the virtual reality (VR) group (n=12) or the control group (n=12). The VR group received VR training, which stimulated the left side of their bodies. The control group rec...

  17. Cognitive training on stroke patients via virtual reality-based serious games.

    Science.gov (United States)

    Gamito, Pedro; Oliveira, Jorge; Coelho, Carla; Morais, Diogo; Lopes, Paulo; Pacheco, José; Brito, Rodrigo; Soares, Fabio; Santos, Nuno; Barata, Ana Filipa

    2017-02-01

    Use of virtual reality environments in cognitive rehabilitation offers cost benefits and other advantages. In order to test the effectiveness of a virtual reality application for neuropsychological rehabilitation, a cognitive training program using virtual reality was applied to stroke patients. A virtual reality-based serious games application for cognitive training was developed, with attention and memory tasks consisting of daily life activities. Twenty stroke patients were randomly assigned to two conditions: exposure to the intervention, and waiting list control. The results showed significant improvements in attention and memory functions in the intervention group, but not in the controls. Overall findings provide further support for the use of VR cognitive training applications in neuropsychological rehabilitation. Implications for Rehabilitation Improvements in memory and attention functions following a virtual reality-based serious games intervention. Training of daily-life activities using a virtual reality application. Accessibility to training contents.

  18. Virtual cases in internal medicine education

    Directory of Open Access Journals (Sweden)

    Ilja Tachecí

    2015-09-01

    Full Text Available Virtual patients represent a useful tool in teaching students clinical reasoning skills. Virtual Cases (www.e-kazuistiky.cz represent a newly developed interactive problem-based learning system, drawing information from virtual clinics, covering different fields of internal medicine, generating sets of unique virtual patients according to user-predefined program settings (spectrum of diagnoses, number of patients and criteria for passing the course. Basic clinical information including personal data, medical history, symptoms, laboratory values, etc. is generated for each virtual patient. The main task for the student is to determine the optimal diagnostic algorithm (choose adequate diagnostic steps in the correct order, and to determine the correct diagnosis in each virtual patient. Results of diagnostics tests and clinical findings are presented utilising a multimedia presentation (images, video-sequences, audio-recordings. Evaluation of students includes not only assessment of correctly determined diagnosis, but also the diagnostic pathway, which led the user to the specific diagnosis. Thus, the system enables assessment of appropriateness of each test as well as reasonable sequencing of tests and also financial costs of all examinations. The program is now routinely used in the undergraduate curriculum at the Medical Faculty in Hradec Králové. User hands-on experience was evaluated through anonymous questionnaires. The most appreciated attribute of the system is the game-like involvement and multimedia-supporting environment (for students as well as the possibility of a detailed analysis of each student’s performance and clear identification of their weakest areas (for tutors. The system is a useful tool for undergraduate medical education with positive feedback from both students and teachers. The main advantages are flexibility, potential for further growth and no restrictions regarding particular disease, clinical discipline

  19. International Survey on the Management of Wake-Up Stroke.

    Science.gov (United States)

    de Castro-Afonso, Luís Henrique; Nakiri, Guilherme Seizem; Pontes-Neto, Octávio Marques; dos Santos, Antônio Carlos; Abud, Daniel Giansante

    2016-01-01

    Patients who wake up having experienced a stroke while asleep represent around 20% of acute stroke admissions. According to international guidelines for the management of acute stroke, patients presenting with wake-up stroke are not currently eligible to receive revascularization treatments. In this study, we aimed to assess the opinions of stroke experts about the management of patients with wake-up stroke by using an international multicenter electronic survey. This study consisted of 8 questions on wake-up stroke treatment. Two hundred invitations to participate in the survey were sent by e-mail. Fifty-nine participants started the survey, 4 dropped out before completing it, and 55 completed the full questionnaire. We had 55 participants from 22 countries. In this study, most stroke experts recommended a recanalization treatment for wake-up stroke. However, there was considerable disagreement among experts regarding the best brain imaging method and the best recanalization treatment. The results of ongoing randomized trials on wake-up stroke are urgently needed.

  20. International Survey on the Management of Wake-Up Stroke

    Directory of Open Access Journals (Sweden)

    Luís Henrique de Castro-Afonso

    2016-03-01

    Full Text Available Background: Patients who wake up having experienced a stroke while asleep represent around 20% of acute stroke admissions. According to international guidelines for the management of acute stroke, patients presenting with wake-up stroke are not currently eligible to receive revascularization treatments. In this study, we aimed to assess the opinions of stroke experts about the management of patients with wake-up stroke by using an international multicenter electronic survey. Method: This study consisted of 8 questions on wake-up stroke treatment. Results: Two hundred invitations to participate in the survey were sent by e-mail. Fifty-nine participants started the survey, 4 dropped out before completing it, and 55 completed the full questionnaire. We had 55 participants from 22 countries. Conclusions: In this study, most stroke experts recommended a recanalization treatment for wake-up stroke. However, there was considerable disagreement among experts regarding the best brain imaging method and the best recanalization treatment. The results of ongoing randomized trials on wake-up stroke are urgently needed.

  1. Astronomical Virtual Observatories Through International Collaboration

    Directory of Open Access Journals (Sweden)

    Masatoshi Ohishi

    2010-03-01

    Full Text Available Astronomical Virtual Observatories (VOs are emerging research environment for astronomy, and 16 countries and a region have funded to develop their VOs based on international standard protocols for interoperability. The 16 funded VO projects have established the International Virtual Observatory Alliance (http://www.ivoa.net/ to develop the standard interoperable interfaces such as registry (meta data, data access, query languages, output format (VOTable, data model, application interface, and so on. The IVOA members have constructed each VO environment through the IVOA interfaces. National Astronomical Observatory of Japan (NAOJ started its VO project (Japanese Virtual Observatory - JVO in 2002, and developed its VO system. We have succeeded to interoperate the latest JVO system with other VOs in the USA and Europe since December 2004. Observed data by the Subaru telescope, satellite data taken by the JAXA/ISAS, etc. are connected to the JVO system. Successful interoperation of the JVO system with other VOs means that astronomers in the world will be able to utilize top-level data obtained by these telescopes from anywhere in the world at anytime. System design of the JVO system, experiences during our development including problems of current standard protocols defined in the IVOA, and proposals to resolve these problems in the near future are described.

  2. Innovative STRoke Interactive Virtual thErapy (STRIVE) online platform for community-dwelling stroke survivors: a randomised controlled trial protocol.

    Science.gov (United States)

    Johnson, Liam; Bird, Marie-Louise; Muthalib, Makii; Teo, Wei-Peng

    2018-01-09

    The STRoke Interactive Virtual thErapy (STRIVE) intervention provides community-dwelling stroke survivors access to individualised, remotely supervised progressive exercise training via an online platform. This trial aims to determine the clinical efficacy of the STRIVE intervention and its effect on brain activity in community-dwelling stroke survivors. In a multisite, assessor-blinded randomised controlled trial, 60 stroke survivors >3 months poststroke with mild-to-moderate upper extremity impairment will be recruited and equally randomised by location (Melbourne, Victoria or Launceston, Tasmania) to receive 8 weeks of virtual therapy (VT) at a local exercise training facility or usual care. Participants allocated to VT will perform 3-5 upper limb exercises individualised to their impairment severity and preference, while participants allocated to usual care will be asked to maintain their usual daily activities. The primary outcome measures will be upper limb motor function and impairment, which will be assessed using the Action Research Arm Test and Upper Extremity Fugl-Meyer, respectively. Secondary outcome measures include upper extremity function and spasticity, as measured by the box and block test and Modified AshworthScale, respectively, and task-related changes in bilateral sensorimotor cortex haemodynamics during hand reaching and wrist extension movements as measured by functional near-infrared spectroscopy. Quality of life will be measured using the Euro-Quality of Life-5 Dimension-5 Level Scale, and the Motor Activity Log-28 will be used to measure use of the hemiparetic arm. All measures will be assessed at baseline and immediately postintervention. The study was approved by the Deakin University Human Research Ethics Committee in May 2017 (No. 2017-087). The results will be disseminated in peer-reviewed journals and presented at major international stroke meetings. ACTRN12617000745347; Pre-results. © Article author(s) (or their employer(s) unless

  3. Upper extremity rehabilitation of stroke: Facilitation of corticospinal excitability using virtual mirror paradigm

    Directory of Open Access Journals (Sweden)

    Kang Youn

    2012-10-01

    Full Text Available Abstract Background Several experimental studies in stroke patients suggest that mirror therapy and various virtual reality programs facilitate motor rehabilitation. However, the underlying mechanisms for these therapeutic effects have not been previously described. Objectives We attempted to delineate the changes in corticospinal excitability when individuals were asked to exercise their upper extremity using a real mirror and virtual mirror. Moreover, we attempted to delineate the role of visual modulation within the virtual environment that affected corticospinal excitability in healthy subjects and stroke patients. Methods A total of 18 healthy subjects and 18 hemiplegic patients were enrolled into the study. Motor evoked potential (MEPs from transcranial magnetic stimulation were recorded in the flexor carpi radialis of the non-dominant or affected upper extremity using three different conditions: (A relaxation; (B real mirror; and (C virtual mirror. Moreover, we compared the MEPs from the virtual mirror paradigm using continuous visual feedback or intermittent visual feedback. Results The rates of amplitude increment and latency decrement of MEPs in both groups were higher during the virtual mirror task than during the real mirror. In healthy subjects and stroke patients, the virtual mirror task with intermittent visual feedback significantly facilitated corticospinal excitability of MEPs compared with continuous visual feedback. Conclusion Corticospinal excitability was facilitated to a greater extent in the virtual mirror paradigm than in the real mirror and in intermittent visual feedback than in the continuous visual feedback, in both groups. This provides neurophysiological evidence supporting the application of the virtual mirror paradigm using various visual modulation technologies to upper extremity rehabilitation in stroke patients.

  4. Promoting Therapists? Use of Motor Learning Strategies within Virtual Reality-Based Stroke Rehabilitation

    OpenAIRE

    Levac, Danielle E.; Glegg, Stephanie M. N.; Sveistrup, Heidi; Colquhoun, Heather; Miller, Patricia; Finestone, Hillel; DePaul, Vincent; Harris, Jocelyn E.; Velikonja, Diana

    2016-01-01

    Purpose Therapists use motor learning strategies (MLSs) to structure practice conditions within stroke rehabilitation. Virtual reality (VR)-based rehabilitation is an MLS-oriented stroke intervention, yet little support exists to assist therapists in integrating MLSs with VR system use. Method A pre-post design evaluated a knowledge translation (KT) intervention incorporating interactive e-learning and practice, in which 11 therapists learned how to integrate MLSs within VR-based therapy. Sel...

  5. Virtual reality for improving balance in patients after stroke: A systematic review and meta-analysis.

    Science.gov (United States)

    Li, Zhen; Han, Xiu-Guo; Sheng, Jing; Ma, Shao-Jun

    2016-05-01

    To evaluate the effectiveness of virtual reality interventions for improving balance in people after stroke. Systematic review and meta-analysis of randomized controlled trials. Studies were obtained by searching the following databases: MEDLINE, CINAHL, EMBASE, Web of Science and CENTRAL. Two reviewers assessed studies for inclusion, extracted data and assessed trial quality. Sixteen studies involving 428 participants were included. People who received virtual reality interventions showed marked improvements in Berg Balance Scale (mean difference: 1.46, 95% confidence interval: 0.09-2.83, Pvirtual reality to improve balance after stroke. © The Author(s) 2015.

  6. Virtual reality rehabilitation for stroke patients: Recent review and research issues

    Science.gov (United States)

    Arip, Eza Surya Mohd; Ismail, Waidah; Nordin, Md Jan; Radman, Abduljalil

    2017-11-01

    Stroke is one of the main causes of disability in the world. In order for stroke survivors to reduce their disability, they need to go through a rehabilitation process to regain back their independence and improve their quality of life. To guide patients in their rehabilitation process and improve their receptiveness in performing repetitive exercises, a new rehabilitation training program using Virtual Reality (VR) technology has been introduced. This has attracted many researchers to explore more on VR technology as a new tool for stroke patient's rehabilitation. This paper presents a review on existing VR systems that have been developed for stroke rehabilitation. First, recent VR systems utilized for rehabilitation after stroke are delineated and categorized. Each of these categories concludes with a discussion on limitations and any issues that arise from it. Finally, a concise summary with significant findings and future possibilities in VR rehabilitation research is presented in table format.

  7. Haptic Systems for Post-Stroke Rehabilitation: from Virtual Reality to Remote Rehabilitation

    OpenAIRE

    Daud, Omar Andres

    2011-01-01

    Haptic devices are becoming a common and significant tool in the perspective of robotic neurorehabilitation for motor learning, particularly in post-stroke patients. As a standard approach, this kind of devices are used in a local environment, where the patient interacts with a virtual environment recreated in the computer's screen. In this sense, a general framework for virtual reality based rehabilitation was developed. All the features of the framework, such as the control loop and the ext...

  8. Virtual obstacle crossing: Reliability and differences in stroke survivors who prospectively experienced falls or no falls.

    Science.gov (United States)

    Punt, Michiel; Bruijn, Sjoerd M; Wittink, Harriet; van de Port, Ingrid G; Wubbels, Gijs; van Dieën, Jaap H

    2017-10-01

    Stroke survivors often fall during walking. To reduce fall risk, gait testing and training with avoidance of virtual obstacles is gaining popularity. However, it is unknown whether and how virtual obstacle crossing is associated with fall risk. The present study assessed whether obstacle crossing characteristics are reliable and assessed differences in stroke survivors who prospectively experienced falls or no falls. We recruited twenty-nine community dwelling chronic stroke survivors. Participants crossed five virtual obstacles with increasing lengths. After a break, the test was repeated to assess test-retest reliability. For each obstacle length and trial, we determined; success rate, leading limb preference, pre and post obstacle distance, margins of stability, toe clearance, and crossing step length and speed. Subsequently, fall incidence was monitored using a fall calendar and monthly phone calls over a six-month period. Test-retest reliability was poor, but improved with increasing obstacle-length. Twelve participants reported at least one fall. No association of fall incidence with any of the obstacle crossing characteristics was found. Given the absence of height of the virtual obstacles, obstacle avoidance may have been relatively easy, allowing participants to cross obstacles in multiple ways, increasing variability of crossing characteristics and reducing the association with fall risk. These finding cast some doubt on current protocols for testing and training of obstacle avoidance in stroke rehabilitation. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Using of virtual reality technology in acute cerebral stroke and their influense on post-stroke affective disorders

    Directory of Open Access Journals (Sweden)

    Maslyuk О.А.

    2014-12-01

    Full Text Available Aim. The study of virtual reality technology in the rehabilitation of patients with cerebral stroke and influence on post stroke affective disorder. Materials and methods. The study included 88 patients with ischemic stroke: 59 men (67% and 29 women (33%. The average age of the patients was 62,05 ± 11,74 years. In the study group included 46 patients, 44 patients in the control group. The groups were matched by age, time from the begin of disease, severity of disease, the severity of motor, affective and cognitive impairments. In addition, in the study group to the program of early rehabilitation to use individual training with virtual reality technology (BTS NIRVANA. The duration of the training was 21 days, 3 times a week for 40 minutes. Results. On the background of rehabilitation in the study group patients had a significant reduced of neurological deficit (p <0,05. Significantly improved neurodynamic and executive cognitive function (p <0,01. In the study group was a statistically significant decrease symptoms of depression on a scale of BDI was 31,7% vs. 20.9% in the control group, anxiety on a scale of HADS was 18,46% (p <0,05 vs. 12,23% (p <0,05 in the control group. Increase motivation and decrease symptoms of apathy in the study group of patients on a scale of AES-C was 13,78% (p <0,05 vs. 1,01 % in the control group. On the background of rehabilitation patients in the study group was no difference between the rates of pathological muscle and mental fatigue. On the background there is rehabilitation of the quality of life due to mobility and activities of daily living. Conclusion. The study showed the positive effect of virtual reality technology for the correction of post-stroke mood disorders.

  10. Virtual Reality Training with Cognitive Load Improves Walking Function in Chronic Stroke Patients.

    Science.gov (United States)

    Cho, Ki Hun; Kim, Min Kyu; Lee, Hwang-Jae; Lee, Wan Hee

    2015-08-01

    Virtual reality training is considered as an effective intervention method of stroke patients, and the virtual reality system for therapeutic rehabilitation has emphasized the cognitive factors to improve walking function. The purpose of current study was to investigate the effect of virtual reality training with cognitive load (VRTCL) on walking function of chronic stroke. Chronic stroke patients were randomly assigned to the VRTCL group (11 patients, including 5 men; mean age, 60.0 years; post-stroke duration, 273.9 days) or control group (11 patients, including 2 men; mean age, 58.6 years; post-stroke duration, 263.9 days). All subjects participated in the standard rehabilitation program that consisted of physical and occupational therapies. In addition, VRTCL group participated in the VRTCL for 4 weeks (30 min per day and five times a week), while those in the control group participated in virtual reality treadmill training. Walking function under single (walking alone) and dual task (walking with cognitive tasks) conditions was assessed using an electrical walkway system. After the 4-week intervention, under both single and dual task conditions, significant improvement on walking function was observed in VRTCL and control groups (P < 0.05). In addition, in the dual task condition, greater improvement on walking function was observed in the VRTCL group, compared with the control group (P < 0.05). These findings demonstrated the efficacy of VRTCL on the walking function under the dual task condition. Therefore, we suggest that VRTCL may be an effective method for the achievement of independent walking in chronic stroke patients.

  11. Virtual reality gaming in the rehabilitation of the upper extremities post-stroke.

    Science.gov (United States)

    Yates, Michael; Kelemen, Arpad; Sik Lanyi, Cecilia

    2016-01-01

    Occurrences of strokes often result in unilateral upper limb dysfunction. Dysfunctions of this nature frequently persist and can present chronic limitations to activities of daily living. Research into applying virtual reality gaming systems to provide rehabilitation therapy have seen resurgence. Themes explored in stroke rehab for paretic limbs are action observation and imitation, versatility, intensity and repetition and preservation of gains. Fifteen articles were ultimately selected for review. The purpose of this literature review is to compare the various virtual reality gaming modalities in the current literature and ascertain their efficacy. The literature supports the use of virtual reality gaming rehab therapy as equivalent to traditional therapies or as successful augmentation to those therapies. While some degree of rigor was displayed in the literature, small sample sizes, variation in study lengths and therapy durations and unequal controls reduce generalizability and comparability. Future studies should incorporate larger sample sizes and post-intervention follow-up measures.

  12. Virtual reality environments for post-stroke arm rehabilitation

    Directory of Open Access Journals (Sweden)

    Beaudoin Christian

    2007-06-01

    Full Text Available Abstract Introduction Optimal practice and feedback elements are essential requirements for maximal motor recovery in patients with motor deficits due to central nervous system lesions. Methods A virtual environment (VE was created that incorporates practice and feedback elements necessary for maximal motor recovery. It permits varied and challenging practice in a motivating environment that provides salient feedback. Results The VE gives the user knowledge of results feedback about motor behavior and knowledge of performance feedback about the quality of pointing movements made in a virtual elevator. Movement distances are related to length of body segments. Conclusion We describe an immersive and interactive experimental protocol developed in a virtual reality environment using the CAREN system. The VE can be used as a training environment for the upper limb in patients with motor impairments.

  13. The effect of virtual reality training on unilateral spatial neglect in stroke patients.

    Science.gov (United States)

    Kim, Yong Mi; Chun, Min Ho; Yun, Gi Jeong; Song, Young Jin; Young, Han Eun

    2011-06-01

    To investigate the effect of virtual reality training on unilateral spatial neglect in stroke patients. Twenty-four stroke patients (14 males and 10 females, mean age=64.7) who had unilateral spatial neglect as a result of right hemisphere stroke were recruited. All patients were randomly assigned to either the virtual reality (VR) group (n=12) or the control group (n=12). The VR group received VR training, which stimulated the left side of their bodies. The control group received conventional neglect therapy such as visual scanning training. Both groups received therapy for 30 minutes a day, five days per week for three weeks. Outcome measurements included star cancellation test, line bisection test, Catherine Bergego scale (CBS), and the Korean version of modified Barthel index (K-MBI). These measurements were taken before and after treatment. There were no significant differences in the baseline characteristics and initial values between the two groups. The changes in star cancellation test results and CBS in the VR group were significantly higher than those of the control group after treatment. The changes in line bisection test score and the K-MBI in the VR group were not statistically significant. This study suggests that virtual reality training may be a beneficial therapeutic technique on unilateral spatial neglect in stroke patients.

  14. Globalisation of water resources: International virtual water flows in relation to international crop trade

    NARCIS (Netherlands)

    Hoekstra, Arjen Ysbert; Hung, P.Q.

    2005-01-01

    The water that is used in the production process of a commodity is called the ‘virtual water’ contained in the commodity. International trade of commodities brings along international flows of virtual water. The objective of this paper is to quantify the volumes of virtual water flows between

  15. Effectiveness of Virtual Reality Using Wii Gaming Technology in Stroke Rehabilitation

    Science.gov (United States)

    Saposnik, Gustavo; Teasell, Robert; Mamdani, Muhammad; Hall, Judith; McIlroy, William; Cheung, Donna; Thorpe, Kevin E.; Cohen, Leonardo G.; Bayley, Mark

    2016-01-01

    Background and Purpose Hemiparesis resulting in functional limitation of an upper extremity is common among stroke survivors. Although existing evidence suggests that increasing intensity of stroke rehabilitation therapy results in better motor recovery, limited evidence is available on the efficacy of virtual reality for stroke rehabilitation. Methods In this pilot, randomized, single-blinded clinical trial with 2 parallel groups involving stroke patients within 2 months, we compared the feasibility, safety, and efficacy of virtual reality using the Nintendo Wii gaming system (VRWii) versus recreational therapy (playing cards, bingo, or “Jenga”) among those receiving standard rehabilitation to evaluate arm motor improvement. The primary feasibility outcome was the total time receiving the intervention. The primary safety outcome was the proportion of patients experiencing intervention-related adverse events during the study period. Efficacy, a secondary outcome measure, was evaluated with the Wolf Motor Function Test, Box and Block Test, and Stroke Impact Scale at 4 weeks after intervention. Results Overall, 22 of 110 (20%) of screened patients were randomized. The mean age (range) was 61.3 (41 to 83) years. Two participants dropped out after a training session. The interventions were successfully delivered in 9 of 10 participants in the VRWii and 8 of 10 in the recreational therapy arm. The mean total session time was 388 minutes in the recreational therapy group compared with 364 minutes in the VRWii group (P=0.75). There were no serious adverse events in any group. Relative to the recreational therapy group, participants in the VRWii arm had a significant improvement in mean motor function of 7 seconds (Wolf Motor Function Test, 7.4 seconds; 95% CI, −14.5, −0.2) after adjustment for age, baseline functional status (Wolf Motor Function Test), and stroke severity. Conclusions VRWii gaming technology represents a safe, feasible, and potentially effective

  16. Rehabilitation after Stroke using Immersive User Interfaces in 3D Virtual and Augmented Gaming Environments

    Directory of Open Access Journals (Sweden)

    E. Vogiatzaki

    2015-05-01

    Full Text Available Stroke is one of most common diseases of our modern societies with high socio-economic impact. Hence, rehabilitation approach involving patients in their rehabilitation process while lowering costly involvement of specialised human personnel is needed. This article describes a novel approach, offering an integrated rehabilitation training for stroke patients using a serious gaming approach based on a Unity3D virtual reality engine combined with a range of advanced technologies and immersive user interfaces. It puts patients and caretakers in control of the rehabilitation protocols, while leading physicians are enabled to supervise the progress of the rehabilitation via Personal Health Record. Possibility to perform training in a familiar home environment directly improves the effectiveness of the rehabilitation. The work presented herein has been conducted within the "StrokeBack" project co-funded by the European Commission under the Framework 7 Program in the ICT domain.

  17. International workshop on multimodal virtual and augmented reality (workshop summary)

    NARCIS (Netherlands)

    Hürst, W.O.; Iwai, Daisuke; Balakrishnan, Prabhakaran

    2016-01-01

    Virtual reality (VR) and augmented reality (AR) are expected by many to become the next wave of computing with significant impacts on our daily lives. Motivated by this, we organized a workshop on “Multimodal Virtual and Augmented Reality (MVAR)” at the 18th ACM International Conference on

  18. The effects of virtual reality on stroke rehabilitation: A systematic review

    Directory of Open Access Journals (Sweden)

    José Eduardo Pompeu

    2014-12-01

    Full Text Available This study aimed to perform a systematic review to verify the effects of virtual reality (VR on the rehabilitation of stroke patients. The search was conducted in the electronic databases Medline, Lilacs, Scielo and PubMed, from 2004 to 2012. The keywords selected for the search were: virtual reality, video game, stroke, physiotherapy, rehabilitation. It was found 893 articles, and at the end of selection, nine studies were included. The results showed that training with VR may contribute to the rehabilitation of stroke patients. The selected studies involved the use of seven different VR systems for training of functions: gait, balance, upper limb function, cognition and perception. Furthermore, depending on the function trained, the authors selected different assessment methods. However, even in the studies with similar functions assessed it was found different measurement techniques. The conclusion was that VR can promote positive effects on rehabilitation of post stroke patients. Despite promising results, further studies are needed with larger numbers of subjects and better methodological quality.

  19. Virtual reality training improves turning capacity and functional reach in stroke patients

    International Nuclear Information System (INIS)

    Malik, A.N.; Masood, T.

    2017-01-01

    Objective: To determine the added effects of virtual reality training on turning capacity, gait parameters and functional reach capacity of stroke patients compared to task oriented training alone. Methodology: A randomized control trial was conducted from February 2016 to July 2106 at Physical Rehabilitation Department Pakistan Railway Hospital, Rawalpindi, Pakistan. Twenty stroke patients were selected through purposive sampling. The patients were randomly assigned through sealed envelope method into two groups; Task Oriented Training (TOT) and Virtual Reality Training (VRT) Group. The standardized tools were used for assessment. The TOT was provided for 4 days per week for 6 weeks while VRT group received additional exer-gaming training during sessions. Results: Significant improvement was observed in both groups regarding reaching forward, turning 360, gait pivot turn (p a 0.01) and FRT (p a 0.001). The two groups were statistically different from each other in terms of turning capacity, reaching forward, gait pivot turn and functional reach after 6 weeks of intervention (p a 0.05) Conclusion: Addition of virtual reality training further improves the significant improvement caused by task oriented training on turning capacity, reaching forward, gait pivot turn and functional reach in stroke patients. (author)

  20. Feasibility of incorporating functionally relevant virtual rehabilitation in sub-acute stroke care: perception of patients and clinicians.

    Science.gov (United States)

    Demers, Marika; Chan Chun Kong, Daniel; Levin, Mindy F

    2018-03-11

    To determine user satisfaction and safety of incorporating a low-cost virtual rehabilitation intervention as an adjunctive therapeutic option for cognitive-motor upper limb rehabilitation in individuals with sub-acute stroke. A low-cost upper limb virtual rehabilitation application incorporating realistic functionally-relevant unimanual and bimanual tasks, specifically designed for cognitive-motor rehabilitation was developed for patients with sub-acute stroke. Clinicians and individuals with stroke interacted with the intervention for 15-20 or 20-45 minutes, respectively. The study had a mixed-methods convergent parallel design that included a focus group interview with clinicians working in a stroke program and semi-structured interviews and standardized assessments (Borg Perceived Exertion Scale, Short Feedback Questionnaire) for participants with sub-acute stroke undergoing rehabilitation. The occurrence of adverse events was also noted. Three main themes emerged from the clinician focus group and patient interviews: Perceived usefulness in rehabilitation, satisfaction with the virtual reality intervention and aspects to improve. All clinicians and the majority of participants with stroke were highly satisfied with the intervention and perceived its usefulness to decrease arm motor impairment during functional tasks. No participants experienced major adverse events. Incorporation of this type of functional activity game-based virtual reality intervention in the sub-acute phase of rehabilitation represents a way to transfer skills learned early in the clinical setting to real world situations. This type of intervention may lead to better integration of the upper limb into everyday activities. Implications for Rehabilitation • Use of a cognitive-motor low-cost virtual reality intervention designed to remediate arm motor impairments in sub-acute stroke is feasible, safe and perceived as useful by therapists and patients for stroke rehabilitation.

  1. Virtual water embodied in international trade of soybean

    DEFF Research Database (Denmark)

    Caro, Dario; Thomsen, Marianne

    This study focuses on hidden water flows embodied in the international trade of soybean. The virtual water content embedded in soybean imported and exported by 174 countries during the period 2000-2013 is estimated.......This study focuses on hidden water flows embodied in the international trade of soybean. The virtual water content embedded in soybean imported and exported by 174 countries during the period 2000-2013 is estimated....

  2. Cerebral Reorganization in Subacute Stroke Survivors after Virtual Reality-Based Training: A Preliminary Study

    Directory of Open Access Journals (Sweden)

    Xiang Xiao

    2017-01-01

    Full Text Available Background. Functional magnetic resonance imaging (fMRI is a promising method for quantifying brain recovery and investigating the intervention-induced changes in corticomotor excitability after stroke. This study aimed to evaluate cortical reorganization subsequent to virtual reality-enhanced treadmill (VRET training in subacute stroke survivors. Methods. Eight participants with ischemic stroke underwent VRET for 5 sections per week and for 3 weeks. fMRI was conducted to quantify the activity of selected brain regions when the subject performed ankle dorsiflexion. Gait speed and clinical scales were also measured before and after intervention. Results. Increased activation in the primary sensorimotor cortex of the lesioned hemisphere and supplementary motor areas of both sides for the paretic foot (p<0.01 was observed postintervention. Statistically significant improvements were observed in gait velocity (p<0.05. The change in voxel counts in the primary sensorimotor cortex of the lesioned hemisphere is significantly correlated with improvement of 10 m walk time after VRET (r=−0.719. Conclusions. We observed improved walking and increased activation in cortical regions of stroke survivors after VRET training. Moreover, the cortical recruitment was associated with better walking function. Our study suggests that cortical networks could be a site of plasticity, and their recruitment may be one mechanism of training-induced recovery of gait function in stroke. This trial is registered with ChiCTR-IOC-15006064.

  3. Training multitasking in a virtual supermarket: a novel intervention after stroke.

    Science.gov (United States)

    Rand, Debbie; Weiss, Patrice L Tamar; Katz, Noomi

    2009-01-01

    To explore the potential of the VMall, a virtual supermarket running on a video-capture virtual reality system, as an intervention tool for people who have multitasking deficits after stroke. Poststroke, 4 participants received ten 60-min sessions over 3 weeks using the VMall. The intervention focused on improving multitasking while the participant was engaged in a virtual shopping task. Instruments included the Multiple Errands Test-Hospital Version (MET-HV) in a real mall and in the VMall. Participants achieved improvements ranging from 20.5% to 51.2% for most of the MET-HV measures performed in a real shopping mall and in the VMall. The data support the VMall's potential as a motivating and effective intervention tool for the rehabilitation of people poststroke who have multitasking deficits during the performance of daily tasks. However, because the sample was small, additional intervention studies with the VMall should be conducted.

  4. Virtual Seafloor Reduces Internal Wave Generation by Tidal Flow

    Science.gov (United States)

    Zhang, Likun; Swinney, Harry L.

    2014-03-01

    Our numerical simulations of tidal flow of a stratified fluid over periodic knife-edge ridges and random topography reveal that the time-averaged tidal energy converted into internal gravity wave radiation arises only from the section of a ridge above a virtual seafloor. The average radiated power is approximated by the power predicted by linear theory if the height of the ridge is measured relative to the virtual floor. The concept of a virtual floor can extend the applicability of linear theory to global predictions of the conversion of tidal energy into internal wave energy in the oceans.

  5. Virtual reality exercise improves mobility after stroke: an inpatient randomized controlled trial.

    Science.gov (United States)

    McEwen, Daniel; Taillon-Hobson, Anne; Bilodeau, Martin; Sveistrup, Heidi; Finestone, Hillel

    2014-06-01

    Exercise using virtual reality (VR) has improved balance in adults with traumatic brain injury and community-dwelling older adults. Rigorous randomized studies regarding its efficacy, safety, and applicability with individuals after stroke are lacking. The purpose of this study was to determine whether an adjunct VR therapy improves balance, mobility, and gait in stroke rehabilitation inpatients. A blinded randomized controlled trial studying 59 stroke survivors on an inpatient stroke rehabilitation unit was performed. The treatment group (n=30) received standard stroke rehabilitation therapy plus a program of VR exercises that challenged balance (eg, soccer goaltending, snowboarding) performed while standing. The control group (n=29) received standard stroke rehabilitation therapy plus exposure to identical VR environments but whose games did not challenge balance (performed in sitting). VR training consisted of 10 to 12 thirty-minute daily sessions for a 3-week period. Objective outcome measures of balance and mobility were assessed before, immediately after, and 1 month after training. Confidence intervals and effect sizes favored the treatment group on the Timed Up and Go and the Two-Minute Walk Test, with both groups meeting minimal clinical important differences after training. More individuals in the treatment group than in the control group showed reduced impairment in the lower extremity as measured by the Chedoke McMaster Leg domain (P=0.04) immediately after training. This VR exercise intervention for inpatient stroke rehabilitation improved mobility-related outcomes. Future studies could include nonambulatory participants as well as the implementation strategies for the clinical use of VR. http://www.ANZCTR.org.au/. Unique identifier: ACTRN12613000710729. © 2014 American Heart Association, Inc.

  6. Virtual reality in stroke rehabilitation: a meta-analysis and implications for clinicians.

    Science.gov (United States)

    Saposnik, Gustavo; Levin, Mindy

    2011-05-01

    Approximately two thirds of stroke survivors continue to experience motor deficits of the arm resulting in diminished quality of life. Conventional rehabilitation provides modest and sometimes delayed effects. Virtual reality (VR) technology is a novel adjunctive therapy that could be applied in neurorehabilitation. We performed a meta-analysis to determine the added benefit of VR technology on arm motor recovery after stroke. We searched Medline, EMBASE, and Cochrane literature from 1966 to July 2010 with the terms "stroke," "virtual reality," and "upper arm/extremity." We evaluated the effect of VR on motor function improvement after stroke. From the 35 studies identified, 12 met the inclusion/exclusion criteria totaling 195 participants. Among them, there were 5 randomized clinical trials and 7 observational studies with a pre-/postintervention design. Interventions were delivered within 4 to 6 weeks in 9 of the studies and within 2 to 3 weeks in the remaining 3. Eleven of 12 studies showed a significant benefit toward VR for the selected outcomes. In the pooled analysis of all 5 randomized controlled trials, the effect of VR on motor impairment (Fugl-Meyer) was OR=4.89 (95% CI, 1.31 to 18.3). No significant difference was observed for Box and Block Test or motor function. Among observational studies, there was a 14.7% (95% CI, 8.7%-23.6%) improvement in motor impairment and a 20.1% (95% CI, 11.0%-33.8%) improvement in motor function after VR. VR and video game applications are novel and potentially useful technologies that can be combined with conventional rehabilitation for upper arm improvement after stroke.

  7. The International Solid Earth Research Virtual Observatory

    Science.gov (United States)

    Fox, G.; Pierce, M.; Rundle, J.; Donnellan, A.; Parker, J.; Granat, R.; Lyzenga, G.; McLeod, D.; Grant, L.

    2004-12-01

    We describe the architecture and initial implementation of the International Solid Earth Research Virtual Observatory (iSERVO). This has been prototyped within the USA as SERVOGrid and expansion is planned to Australia, China, Japan and other countries. We base our design on a globally scalable distributed "cyber-infrastructure" or Grid built around a Web Services-based approach consistent with the extended Web Service Interoperability approach. The Solid Earth Science Working Group of NASA has identified several challenges for Earth Science research. In order to investigate these, we need to couple numerical simulation codes and data mining tools to observational data sets. This observational data are now available on-line in internet-accessible forms, and the quantity of this data is expected to grow explosively over the next decade. We architect iSERVO as a loosely federated Grid of Grids with each country involved supporting a national Solid Earth Research Grid. The national Grid Operations, possibly with dedicated control centers, are linked together to support iSERVO where an International Grid control center may eventually be necessary. We address the difficult multi-administrative domain security and ownership issues by exposing capabilities as services for which the risk of abuse is minimized. We support large scale simulations within a single domain using service-hosted tools (mesh generation, data repository and sensor access, GIS, visualization). Simulations typically involve sequential or parallel machines in a single domain supported by cross-continent services. We use Web Services implement Service Oriented Architecture (SOA) using WSDL for service description and SOAP for message formats. These are augmented by UDDI, WS-Security, WS-Notification/Eventing and WS-ReliableMessaging in the WS-I+ approach. Support for the latter two capabilities will be available over the next 6 months from the NaradaBrokering messaging system. We augment these

  8. Virtual reality for stroke rehabilitation: an abridged version of a Cochrane review.

    Science.gov (United States)

    Laver, K; George, S; Thomas, S; Deutsch, J E; Crotty, M

    2015-08-01

    Virtual reality and interactive video gaming have emerged as new treatment approaches in stroke rehabilitation settings over the last ten years. The primary objective of this review was to determine the effectiveness of virtual reality on upper limb function and activity after stroke. The impact on secondary outcomes including gait, cognitive function and activities of daily living was also assessed. Randomized and quasi-randomized controlled trials comparing virtual reality with an alternative intervention or no intervention were eligible to be included in the review. The authors searched a number of electronic databases including: the Cochrane Stroke Group Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, clinical trial registers, reference lists, Dissertation Abstracts and contacted key researchers in the field. Search results were independently examined by two review authors to identify studies meeting the inclusion criteria. A total of 37 randomized or quasi randomized controlled trials with a total of 1019 participants were included in the review. Virtual reality was found to be significantly more effective than conventional therapy in improving upper limb function (standardized mean difference [SMD] 0.28, 95% confidence intervals [CI] 0.08 to 0.49) based on 12 studies and significantly more effective than no therapy in improving upper limber function (SMD 0.44 [95% CI 0.15 to 0.73]) based on nine studies. The use of virtual reality also significantly improved activities of daily living function when compared to more conventional therapy approaches (SMD 0.43 [95% CI 0.18 to 0.69]) based on eight studies. While there are a large number of studies assessing the efficacy of virtual reality they tend to be small and many are at risk of bias. While there is evidence to support the use of virtual reality intervention as part of upper limb training programs, more research is required to determine whether it

  9. Effects of virtual reality-based bilateral upper-extremity training on brain activity in post-stroke patients.

    Science.gov (United States)

    Lee, Su-Hyun; Kim, Yu-Mi; Lee, Byoung-Hee

    2015-07-01

    [Purpose] This study investigated the therapeutic effects of virtual reality-based bilateral upper-extremity training on brain activity in patients with stroke. [Subjects and Methods] Eighteen chronic stroke patients were divided into two groups: the virtual reality-based bilateral upper-extremity training group (n = 10) and the bilateral upper-limb training group (n = 8). The virtual reality-based bilateral upper-extremity training group performed bilateral upper-extremity exercises in a virtual reality environment, while the bilateral upper-limb training group performed only bilateral upper-extremity exercise. All training was conducted 30 minutes per day, three times per week for six weeks, followed by brain activity evaluation. [Results] Electroencephalography showed significant increases in concentration in the frontopolar 2 and frontal 4 areas, and significant increases in brain activity in the frontopolar 1 and frontal 3 areas in the virtual reality-based bilateral upper-extremity training group. [Conclusion] Virtual reality-based bilateral upper-extremity training can improve the brain activity of stroke patients. Thus, virtual reality-based bilateral upper-extremity training is feasible and beneficial for improving brain activation in stroke patients.

  10. Multi-User Virtual Reality Therapy for Post-Stroke Hand Rehabilitation at Home

    Directory of Open Access Journals (Sweden)

    Daria Tsoupikova

    2016-04-01

    Full Text Available Our paper describes the development of a novel multi-user virtual reality (VR system for post-stroke rehabilitation that can be used independently in the home to improve upper extremity motor function. This is the pre-clinical phase of an ongoing collaborative, interdisciplinary research project at the Rehabilitation Institute of Chicago involving a team of engineers, researchers, occupational therapists and artists. This system was designed for creative collaboration within a virtual environment to increase patients' motivation, further engagement and to alleviate the impact of social isolation following stroke. This is a low-cost system adapted to everyday environments and designed to run on a personal computer that combines three VR environments with audio integration, wireless Kinect tracking and hand motion tracking sensors. Three different game exercises for this system were developed to encourage repetitive task practice, collaboration and competitive interaction. The system is currently being tested with 15 subjects in three settings: a multi-user VR, a single-user VR and at a tabletop with standard exercises to examine the level of engagement and to compare resulting functional performance across methods. We hypothesize that stroke survivors will become more engaged in therapy when training with a multi-user VR system and this will translate into greater gains.

  11. The use of Virtual Reality for upper limb rehabilitation of hemiparetic Stroke patients

    Directory of Open Access Journals (Sweden)

    Antonio Vinicius Soares

    Full Text Available Introduction The Stroke is a neurologic disturbs that leads to a serious impact to the functionality and the quality of life of the survivors. It is necessary to develop new tools with rehabilitation objectives, where the Virtual Reality (VR is introduced as a useful therapeutic resource to the motor recovery, in an attractive and efficient way, restoring functions through adapted games. Objective Analyzing the therapeutic effects of the Virtual Reality (Serious Game in the recovery of the upper limb in hemiparetic Stroke patients. Methods Quasi-experimental research type time series, there are three pre and three post-tests already accomplished around 20 VR sessions. In the assessments the following measurement instruments were used: Fugl-Meyer Scale – session of the upper limb (FMS - UL; Range of Motion (ROM for flexion and abduction shoulder; Box and Block Test (BBT; Nine Holes and Peg Test (9HPT; the Nottingham Health Profile (NHP; and the Modified Ashworth Scale (MAS. Results Significant gains were observed in the FMS-UL tests, with increase of 25.6%; increase ROM of shoulder with 34.0% for abduction and 19% for flexion; BBT 25.0%; also reported improvement in quality of life by NHP; it did not occurred significant alterations for 9HPT nor in MAS. Conclusion Although the results found in this research are preliminary, they are indicative that the VR can contribute for the recovery of the upper limb in hemiparetic Stroke patients.

  12. Therapeutic Effect of Virtual Reality on Post-Stroke Patients: Randomized Clinical Trial.

    Science.gov (United States)

    Pedreira da Fonseca, Erika; Ribeiro da Silva, Nildo Manoel; Pinto, Elen Beatriz

    2017-01-01

    The study aimed to check the therapeutic effect of virtual reality associated with conventional physiotherapy on gait balance and the occurrence of falls after a stroke. This was a randomized, blinded clinical trial conducted with post-stroke patients, randomized into two groups-treatment group and control group-and subjected to balance assessments by the Dynamic Gait Index and investigation of falls before and after 20 intervention sessions. Statistically significant difference was considered at P < .05. We selected 30 patients, but there were three segment losses, resulting in a total of 13 patients in the control group and 14 in the treatment group. There was an improvement in gait balance and reduced occurrence of falls in both groups. After intervention, the differences in gait balance in the control group (P = .047) and the reduction in the occurrence of falls in the treatment group (P = .049) were significant. However, in intergroup analysis, there was no difference in the two outcomes. Therapy with games was a useful tool for gait balance rehabilitation in post-stroke patients, with repercussions on the reduction of falls. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  13. Celebrating international collaboration: reflections on the first Virtual International Practice Development Conference

    Directory of Open Access Journals (Sweden)

    Moira Stephens

    2016-11-01

    Full Text Available This article reports on the first Virtual International Practice Development Conference, held in May 2015 to celebrate International Nurses Day. The article describes key aspects of its planning, offers a flavour of the event itself and sets out an evaluation, including learning points and recommendations to assist with planning similar events in the future. Central to our learning are: The need for practice developers to grasp skills in technology associated with virtual space The need to embrace virtual space itself as another means by which creative and communicative spaces can be established for active learning and practice development activities The potential advantages that international virtual engagement has over face-to-face national or international engagement The delivery of this virtual event made a significant international contribution to global practice development activity within the International Practice Development Collaborative and to enabling practice developers to connect and celebrate on a more global basis. Implications for practice: Virtual space technology skills can assist with sharing and translating practice development research, innovations and critical commentary Virtual space can provide an adjunct to creative and communicative learning spaces Global networking opportunities can be developed and enhanced through the use of virtual space technology Practice developers need to role model the use of virtual technologies

  14. Proprioception rehabilitation training system for stroke patients using virtual reality technology.

    Science.gov (United States)

    Kim, Sun I; Song, In-Ho; Cho, Sangwoo; Kim, In Young; Ku, Jeonghun; Kang, Youn Joo; Jang, Dong Pyo

    2013-01-01

    We investigated a virtual reality (VR) proprioceptive rehabilitation system that could manipulate the visual feedback of upper-limb during training and could do training by relying on proprioception feedback only. Virtual environments were designed in order to switch visual feedback on/off during upper-limb training. Two types of VR training tasks were designed for evaluating the effect of the proprioception focused training compared to the training with visual feedback. In order to evaluate the developed proprioception feedback virtual environment system, we recruited ten stroke patients (age: 54.7± 7.83years, on set: 3.29± 3.83 years). All patients performed three times PFVE task in order to check the improvement of proprioception function just before training session, after one week training, and after all training. In a comparison between FMS score and PFVE, the FMS score had a significant relationship with the error distance(r = -.662, n=10, p = .037) and total movement distance(r = -.726, n=10, p = .018) in PFVE. Comparing the training effect between in virtual environment with visual feedback and with proprioception, the click count, error distance and total error distance was more reduced in PFVE than VFVE. (Click count: p = 0.005, error distance: p = 0.001, total error distance: p = 0.007). It suggested that the proprioception feedback rather than visual feedback could be effective means to enhancing motor control during rehabilitation training. The developed VR system for rehabilitation has been verified in that stroke patients improved motor control after VR proprioception feedback training.

  15. Occupational emerging risks affecting international virtual project Team Results

    Directory of Open Access Journals (Sweden)

    Dumitraşcu-Băldău Iulia

    2017-01-01

    Full Text Available The expansion of internet access, high-speed connection services, collaborative work platforms and tools, allowed employees to interact virtually offering companies the possibility to develop projects around the world, reducing operational costs and gain competitive advantage. Realizing the advantages and disadvantages of developing a project team in an international virtual work environment, requires adopting specific strategies to construct an effective team and ensure the project success. One of the most important disadvantages that we identified is that the new work environment brings new risks for both team members and managers. So, it becomes mandatory to identify and analyze the occupational emerging risks and their impact on the productivity of virtual team members, in order to prevent them efficiently and to ensure the safety and health of employees in a virtual working environment. This paper aims to highlight the necessity for project managers and organizations, to include in their specific project strategies, an efficient occupational risks management in the virtual workplace, to obtain a continuously improved virtual working environment, so to achieve a high performance from virtual employees.

  16. Effect of a rehabilitation program using virtual reality for balance and functionality of chronic stroke patients

    Directory of Open Access Journals (Sweden)

    Wagner Henrique Souza Silva

    2015-09-01

    Full Text Available AbstractThis study aimed to investigate the effect of a rehabilitation program using virtual reality (VR in addition to conventional therapy for improvement of balance (BERG scale and functional independence (FIM scale in chronic stroke patients. Ten individuals, mean age of 51.4 (± 6.7 years, participated of eight 60-minute sessions comprising kinesiotherapy (15min, Nintendo Wii (30min and Learning transfer (15min exercises. After training, nonparametric statistical analysis showed significant improvement in total FIM (p= .01 and BERG scores (p= .00, and in some of their subitems: FIM - dressing lower body (p= .01, transfer to bathtub/shower (p= .02 and locomotion: stairs (p= .03; BERG - reaching forward with outstretched arm (p= .01, retrieving object from the floor (p= .04, turning 360º (p= .01, placing alternate foot on step (p≤ .01, standing with one foot in front (p= .01, and one leg stand (p= .03. These findings suggest a positive influence of virtual reality exercises adjunct to conventional therapy on rehabilitation of balance and functionality post stroke, and indicate the feasibility of the proposed VR-based rehabilitation program.

  17. Effects of virtual reality training using Nintendo Wii and treadmill walking exercise on balance and walking for stroke patients.

    Science.gov (United States)

    Bang, Yo-Soon; Son, Kyung Hyun; Kim, Hyun Jin

    2016-11-01

    [Purpose] The purpose of this study is to investigate the effects of virtual reality training using Nintendo Wii on balance and walking for stroke patients. [Subjects and Methods] Forty stroke patients with stroke were randomly divided into two exercise program groups: virtual reality training (n=20) and treadmill (n=20). The subjects underwent their 40-minute exercise program three times a week for eight weeks. Their balance and walking were measured before and after the complete program. We measured the left/right weight-bearing and the anterior/posterior weight-bearing for balance, as well as stance phase, swing phase, and cadence for walking. [Results] For balance, both groups showed significant differences in the left/right and anterior/posterior weight-bearing, with significant post-program differences between the groups. For walking, there were significant differences in the stance phase, swing phase, and cadence of the virtual reality training group. [Conclusion] The results of this study suggest that virtual reality training providing visual feedback may enable stroke patients to directly adjust their incorrect weight center and shift visually. Virtual reality training may be appropriate for patients who need improved balance and walking ability by inducing their interest for them to perform planned exercises on a consistent basis.

  18. Requirements Elicitation and Prototyping of a Fully Immersive Virtual Reality Gaming System for Upper Limb Stroke Rehabilitation in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Maram AlMousa

    2017-01-01

    Full Text Available Stroke rehabilitation plays an important role in recovering the lifestyle of stroke survivors. Although existing research proved the effectiveness and engagement of nonimmersive virtual reality- (VR- based rehabilitation systems, limited research is available on the applicability of fully immersive VR-based rehabilitation systems. In this paper, we present the elicited requirements of a fully immersive VR-based rehabilitation system that will be designed for domestic upper limb stroke patients; we will also provide an initial conceptual prototype of the proposed system.

  19. Virtual Reality Rehabilitation from Social Cognitive and Motor Learning Theoretical Perspectives in Stroke Population

    Directory of Open Access Journals (Sweden)

    Bita Imam

    2014-01-01

    Full Text Available Objectives. To identify the virtual reality (VR interventions used for the lower extremity rehabilitation in stroke population and to explain their underlying training mechanisms using Social Cognitive (SCT and Motor Learning (MLT theoretical frameworks. Methods. Medline, Embase, Cinahl, and Cochrane databases were searched up to July 11, 2013. Randomized controlled trials that included a VR intervention for lower extremity rehabilitation in stroke population were included. The Physiotherapy Evidence Database (PEDro scale was used to assess the quality of the included studies. The underlying training mechanisms involved in each VR intervention were explained according to the principles of SCT (vicarious learning, performance accomplishment, and verbal persuasion and MLT (focus of attention, order and predictability of practice, augmented feedback, and feedback fading. Results. Eleven studies were included. PEDro scores varied from 3 to 7/10. All studies but one showed significant improvement in outcomes in favour of the VR group (P<0.05. Ten VR interventions followed the principle of performance accomplishment. All the eleven VR interventions directed subject’s attention externally, whereas nine provided training in an unpredictable and variable fashion. Conclusions. The results of this review suggest that VR applications used for lower extremity rehabilitation in stroke population predominantly mediate learning through providing a task-oriented and graduated learning under a variable and unpredictable practice.

  20. 78 FR 57921 - Patch International, Inc., QuadTech International, Inc., Strategic Resources, Ltd., and Virtual...

    Science.gov (United States)

    2013-09-20

    ... International, Inc., Strategic Resources, Ltd., and Virtual Medical Centre, Inc.; Order of Suspension of Trading... lack of current and accurate information concerning the securities of Virtual Medical Centre, Inc... October 1, 2013. By the Commission. Jill M. Peterson, Assistant Secretary. [FR Doc. 2013-23043 Filed 9-18...

  1. Upper Limb Kinematics in Stroke and Healthy Controls Using Target-to-Target Task in Virtual Reality

    Directory of Open Access Journals (Sweden)

    Netha Hussain

    2018-05-01

    Full Text Available BackgroundKinematic analysis using virtual reality (VR environment provides quantitative assessment of upper limb movements. This technique has rarely been used in evaluating motor function in stroke despite its availability in stroke rehabilitation.ObjectiveTo determine the discriminative validity of VR-based kinematics during target-to-target pointing task in individuals with mild or moderate arm impairment following stroke and in healthy controls.MethodsSixty-seven participants with moderate (32–57 points or mild (58–65 points stroke impairment as assessed with Fugl-Meyer Assessment for Upper Extremity were included from the Stroke Arm Longitudinal study at the University of Gothenburg—SALGOT cohort of non-selected individuals within the first year of stroke. The stroke groups and 43 healthy controls performed the target-to-target pointing task, where 32 circular targets appear one after the other and disappear when pointed at by the haptic handheld stylus in a three-dimensional VR environment. The kinematic parameters captured by the stylus included movement time, velocities, and smoothness of movement.ResultsThe movement time, mean velocity, and peak velocity were discriminative between groups with moderate and mild stroke impairment and healthy controls. The movement time was longer and mean and peak velocity were lower for individuals with stroke. The number of velocity peaks, representing smoothness, was also discriminative and significantly higher in both stroke groups (mild, moderate compared to controls. Movement trajectories in stroke more frequently showed clustering (spider’s web close to the target indicating deficits in movement precision.ConclusionThe target-to-target pointing task can provide valuable and specific information about sensorimotor impairment of the upper limb following stroke that might not be captured using traditional clinical scale.Trial registration detailsThe trial was registered with register number

  2. Upper Limb Kinematics in Stroke and Healthy Controls Using Target-to-Target Task in Virtual Reality.

    Science.gov (United States)

    Hussain, Netha; Alt Murphy, Margit; Sunnerhagen, Katharina S

    2018-01-01

    Kinematic analysis using virtual reality (VR) environment provides quantitative assessment of upper limb movements. This technique has rarely been used in evaluating motor function in stroke despite its availability in stroke rehabilitation. To determine the discriminative validity of VR-based kinematics during target-to-target pointing task in individuals with mild or moderate arm impairment following stroke and in healthy controls. Sixty-seven participants with moderate (32-57 points) or mild (58-65 points) stroke impairment as assessed with Fugl-Meyer Assessment for Upper Extremity were included from the Stroke Arm Longitudinal study at the University of Gothenburg-SALGOT cohort of non-selected individuals within the first year of stroke. The stroke groups and 43 healthy controls performed the target-to-target pointing task, where 32 circular targets appear one after the other and disappear when pointed at by the haptic handheld stylus in a three-dimensional VR environment. The kinematic parameters captured by the stylus included movement time, velocities, and smoothness of movement. The movement time, mean velocity, and peak velocity were discriminative between groups with moderate and mild stroke impairment and healthy controls. The movement time was longer and mean and peak velocity were lower for individuals with stroke. The number of velocity peaks, representing smoothness, was also discriminative and significantly higher in both stroke groups (mild, moderate) compared to controls. Movement trajectories in stroke more frequently showed clustering (spider's web) close to the target indicating deficits in movement precision. The target-to-target pointing task can provide valuable and specific information about sensorimotor impairment of the upper limb following stroke that might not be captured using traditional clinical scale. The trial was registered with register number NCT01115348 at clinicaltrials.gov, on May 4, 2010. URL: https://clinicaltrials.gov/ct2

  3. Walking training associated with virtual reality-based training increases walking speed of individuals with chronic stroke: systematic review with meta-analysis

    OpenAIRE

    Juliana M. Rodrigues-Baroni; Lucas R. Nascimento; Louise Ada; Luci F. Teixeira-Salmela

    2014-01-01

    OBJECTIVE: To systematically review the available evidence on the efficacy of walking training associated with virtual reality-based training in patients with stroke. The specific questions were: Is walking training associated with virtual reality-based training effective in increasing walking speed after stroke? Is this type of intervention more effective in increasing walking speed, than non-virtual reality-based walking interventions? METHOD: A systematic review with meta-analysis of rando...

  4. Virtual reality and robotics for stroke rehabilitation: where do we go from here?

    Science.gov (United States)

    Wade, Eric; Winstein, Carolee J

    2011-01-01

    Promoting functional recovery after stroke requires collaborative and innovative approaches to neurorehabilitation research. Task-oriented training (TOT) approaches that include challenging, adaptable, and meaningful activities have led to successful outcomes in several large-scale multisite definitive trials. This, along with recent technological advances of virtual reality and robotics, provides a fertile environment for furthering clinical research in neurorehabilitation. Both virtual reality and robotics make use of multimodal sensory interfaces to affect human behavior. In the therapeutic setting, these systems can be used to quantitatively monitor, manipulate, and augment the users' interaction with their environment, with the goal of promoting functional recovery. This article describes recent advances in virtual reality and robotics and the synergy with best clinical practice. Additionally, we describe the promise shown for automated assessments and in-home activity-based interventions. Finally, we propose a broader approach to ensuring that technology-based assessment and intervention complement evidence-based practice and maintain a patient-centered perspective.

  5. Stroking the Net Whale: A Constructivist Grounded Theory of Self-Regulated Learning in Virtual Social Spaces

    Science.gov (United States)

    Kasperiuniene, Judita; Zydziunaite, Vilma; Eriksson, Malin

    2017-01-01

    This qualitative study explored the self-regulated learning (SRL) of teachers and their students in virtual social spaces. The processes of SRL were analyzed from 24 semi-structured individual interviews with professors, instructors and their students from five Lithuanian universities. A core category stroking the net whale showed the process of…

  6. Reinforced Feedback in Virtual Environment for Rehabilitation of Upper Extremity Dysfunction after Stroke: Preliminary Data from a Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Paweł Kiper

    2014-01-01

    Full Text Available Objectives. To study whether the reinforced feedback in virtual environment (RFVE is more effective than traditional rehabilitation (TR for the treatment of upper limb motor function after stroke, regardless of stroke etiology (i.e., ischemic, hemorrhagic. Design. Randomized controlled trial. Participants. Forty-four patients affected by stroke. Intervention. The patients were randomized into two groups: RFVE (N=23 and TR (N=21, and stratified according to stroke etiology. The RFVE treatment consisted of multidirectional exercises providing augmented feedback provided by virtual reality, while in the TR treatment the same exercises were provided without augmented feedbacks. Outcome Measures. Fugl-Meyer upper extremity scale (F-M UE, Functional Independence Measure scale (FIM, and kinematics parameters (speed, time, and peak. Results. The F-M UE (P=0.030, FIM (P=0.021, time (P=0.008, and peak (P=0.018, were significantly higher in the RFVE group after treatment, but not speed (P=0.140. The patients affected by hemorrhagic stroke significantly improved FIM (P=0.031, time (P=0.011, and peak (P=0.020 after treatment, whereas the patients affected by ischemic stroke improved significantly only speed (P=0.005 when treated by RFVE. Conclusion. These results indicated that some poststroke patients may benefit from RFVE program for the recovery of upper limb motor function. This trial is registered with NCT01955291.

  7. Patients’ and Health Professionals’ Experiences of Using Virtual Reality Technology for Upper Limb Training after Stroke:

    DEFF Research Database (Denmark)

    Pallesen, Hanne; Andersen, Mette Brændstrup; Hansen, Gunhild Mo

    2018-01-01

    Background. In recent years, virtual reality (VR) therapy systems for upper limb training after stroke have been increasingly used in clinical practice.Therapy systems employing VR technology can enhance the intensity of training and can also boost patients’ motivation by adding a playful element...... to therapy. However, reports on user experiences are still scarce. Methods. A qualitative investigation of patients’ and therapists’ perspectives on VR upper limb training. Semistructured face-to-face interviews were conducted with six patients in the final week of the VR intervention.Therapists participated......) engagement, (iii) perceived improvements, (iv) individualization, and (v) device malfunction. The health professionals described the same themes as the patients but less positively, emphasizing negative technical challenges. Conclusion. Patients and therapists mainly valued the intensive and motivational...

  8. Promoting Therapists' Use of Motor Learning Strategies within Virtual Reality-Based Stroke Rehabilitation.

    Directory of Open Access Journals (Sweden)

    Danielle E Levac

    Full Text Available Therapists use motor learning strategies (MLSs to structure practice conditions within stroke rehabilitation. Virtual reality (VR-based rehabilitation is an MLS-oriented stroke intervention, yet little support exists to assist therapists in integrating MLSs with VR system use.A pre-post design evaluated a knowledge translation (KT intervention incorporating interactive e-learning and practice, in which 11 therapists learned how to integrate MLSs within VR-based therapy. Self-report and observer-rated outcome measures evaluated therapists' confidence, clinical reasoning and behaviour with respect to MLS use. A focus group captured therapists' perspectives on MLS use during VR-based therapy provision.The intervention improved self-reported confidence about MLS use as measured by confidence ratings (p <0.001. Chart-Stimulated Recall indicated a moderate level of competency in therapists' clinical reasoning about MLSs following the intervention, with no changes following additional opportunities to use VR (p = .944. On the Motor Learning Strategy Rating Instrument, no behaviour change with respect to MLS use was noted (p = 0.092. Therapists favoured the strategy of transferring skills from VR to real-life tasks over employing a more comprehensive MLS approach.The KT intervention improved therapists' confidence but did not have an effect on clinical reasoning or behaviour with regard to MLS use during VR-based therapy.

  9. Virtual reality rehabilitation from social cognitive and motor learning theoretical perspectives in stroke population.

    Science.gov (United States)

    Imam, Bita; Jarus, Tal

    2014-01-01

    Objectives. To identify the virtual reality (VR) interventions used for the lower extremity rehabilitation in stroke population and to explain their underlying training mechanisms using Social Cognitive (SCT) and Motor Learning (MLT) theoretical frameworks. Methods. Medline, Embase, Cinahl, and Cochrane databases were searched up to July 11, 2013. Randomized controlled trials that included a VR intervention for lower extremity rehabilitation in stroke population were included. The Physiotherapy Evidence Database (PEDro) scale was used to assess the quality of the included studies. The underlying training mechanisms involved in each VR intervention were explained according to the principles of SCT (vicarious learning, performance accomplishment, and verbal persuasion) and MLT (focus of attention, order and predictability of practice, augmented feedback, and feedback fading). Results. Eleven studies were included. PEDro scores varied from 3 to 7/10. All studies but one showed significant improvement in outcomes in favour of the VR group (P learning through providing a task-oriented and graduated learning under a variable and unpredictable practice.

  10. Promoting Therapists' Use of Motor Learning Strategies within Virtual Reality-Based Stroke Rehabilitation.

    Science.gov (United States)

    Levac, Danielle E; Glegg, Stephanie M N; Sveistrup, Heidi; Colquhoun, Heather; Miller, Patricia; Finestone, Hillel; DePaul, Vincent; Harris, Jocelyn E; Velikonja, Diana

    2016-01-01

    Therapists use motor learning strategies (MLSs) to structure practice conditions within stroke rehabilitation. Virtual reality (VR)-based rehabilitation is an MLS-oriented stroke intervention, yet little support exists to assist therapists in integrating MLSs with VR system use. A pre-post design evaluated a knowledge translation (KT) intervention incorporating interactive e-learning and practice, in which 11 therapists learned how to integrate MLSs within VR-based therapy. Self-report and observer-rated outcome measures evaluated therapists' confidence, clinical reasoning and behaviour with respect to MLS use. A focus group captured therapists' perspectives on MLS use during VR-based therapy provision. The intervention improved self-reported confidence about MLS use as measured by confidence ratings (p behaviour change with respect to MLS use was noted (p = 0.092). Therapists favoured the strategy of transferring skills from VR to real-life tasks over employing a more comprehensive MLS approach. The KT intervention improved therapists' confidence but did not have an effect on clinical reasoning or behaviour with regard to MLS use during VR-based therapy.

  11. Mobile game-based virtual reality rehabilitation program for upper limb dysfunction after ischemic stroke.

    Science.gov (United States)

    Choi, Yoon-Hee; Ku, Jeonghun; Lim, Hyunmi; Kim, Yeo Hyung; Paik, Nam-Jong

    2016-05-02

    Virtual reality (VR) has the potential to provide intensive, repetitive, and task-oriented training, and game-based therapy can enhance patients' motivation and enjoyment. The objective of the present study was to develop a mobile game-based upper extremity VR program for patients who have experienced stroke, and to evaluate the feasibility and effectiveness of the program. This randomized, double-blind, controlled trial included 24 patients with ischemic stroke. The intervention group (n = 12) received 30 min of conventional occupational therapy (OT) and 30 min of the mobile upper extremity rehabilitation program using a smartphone and a tablet PC (MoU-Rehab). The controls (n = 12) received conventional OT alone for 1 h per day. Rehabilitation consisted of 10 sessions of therapy, 5 days per week, for 2 weeks. The outcome measures (Fugl-Meyer Assessment of the upper extremity [FMA-UE], Brunnström stage [B-stage] for the arm and the hand, manual muscle testing [MMT], modified Barthel index [MBI], EuroQol-5 Dimension [EQ-5D], and Beck Depression Inventory [BDI]) were assessed at the beginning and end of treatment, and at 1 month. User satisfaction was evaluated by a questionnaire. A greater improvement in the FMA-UE, B-stage, and MMT was found after treatment with the MoU-Rehab than with conventional therapy. The extent of improvements in the MBI, EQ-5D, and BDI was not significantly different between the two groups. Patients in the experimental group completed the 2-weeks treatment without adverse effects, and they were generally satisfied with MoU-Rehab. This mobile game-based VR rehabilitation program appears to be feasible and effective for promoting upper limb recovery after ischemic stroke.

  12. Exploring barriers and facilitators to the clinical use of virtual reality for post-stroke unilateral spatial neglect assessment.

    Science.gov (United States)

    Ogourtsova, Tatiana; Archambault, Philippe S; Lamontagne, Anouk

    2017-11-07

    Hemineglect, defined as a failure to attend to the contralesional side of space, is a prevalent and disabling post-stroke deficit. Conventional hemineglect assessments lack sensitivity as they contain mainly non-functional tasks performed in near-extrapersonal space, using static, two-dimensional methods. This is of concern given that hemineglect is a strong predictor for functional deterioration, limited post-stroke recovery, and difficulty in community reintegration. With the emerging field of virtual reality, several virtual tools have been proposed and have reported better sensitivity in neglect-related deficits detection than conventional methods. However, these and future virtual reality-based tools are yet to be implemented in clinical practice. The present study aimed to explore the barriers/facilitators perceived by clinicians in the use of virtual reality for hemineglect assessment; and to identify features of an optimal virtual assessment. A qualitative descriptive process, in the form of focus groups, self-administered questionnaire and individual interviews was used. Two focus groups (n = 11 clinicians) were conducted and experts in the field (n = 3) were individually interviewed. Several barriers and facilitators, including personal, institutional, client suitability, and equipment factors, were identified. Clinicians and experts in the field reported numerous features for the virtual tool optimization. Factors identified through this study lay the foundation for the development of a knowledge translation initiative towards an implementation of a virtual assessment for hemineglect. Addressing the identified barriers/facilitators during implementation and incorporating the optimal features in the design of the virtual assessment could assist and promote its eventual adoption in clinical settings. Implications for rehabilitation A multimodal and active knowledge translation intervention built on the presently identified modifiable factors is

  13. Virtual Reality Simulation of the International Space Welding Experiment

    Science.gov (United States)

    Phillips, James A.

    1996-01-01

    Virtual Reality (VR) is a set of breakthrough technologies that allow a human being to enter and fully experience a 3-dimensional, computer simulated environment. A true virtual reality experience meets three criteria: (1) It involves 3-dimensional computer graphics; (2) It includes real-time feedback and response to user actions; and (3) It must provide a sense of immersion. Good examples of a virtual reality simulator are the flight simulators used by all branches of the military to train pilots for combat in high performance jet fighters. The fidelity of such simulators is extremely high -- but so is the price tag, typically millions of dollars. Virtual reality teaching and training methods are manifestly effective, and we have therefore implemented a VR trainer for the International Space Welding Experiment. My role in the development of the ISWE trainer consisted of the following: (1) created texture-mapped models of the ISWE's rotating sample drum, technology block, tool stowage assembly, sliding foot restraint, and control panel; (2) developed C code for control panel button selection and rotation of the sample drum; (3) In collaboration with Tim Clark (Antares Virtual Reality Systems), developed a serial interface box for the PC and the SGI Indigo so that external control devices, similar to ones actually used on the ISWE, could be used to control virtual objects in the ISWE simulation; (4) In collaboration with Peter Wang (SFFP) and Mark Blasingame (Boeing), established the interference characteristics of the VIM 1000 head-mounted-display and tested software filters to correct the problem; (5) In collaboration with Peter Wang and Mark Blasingame, established software and procedures for interfacing the VPL DataGlove and the Polhemus 6DOF position sensors to the SGI Indigo serial ports. The majority of the ISWE modeling effort was conducted on a PC-based VR Workstation, described below.

  14. A knowledge translation intervention to enhance clinical application of a virtual reality system in stroke rehabilitation.

    Science.gov (United States)

    Levac, Danielle; Glegg, Stephanie M N; Sveistrup, Heidi; Colquhoun, Heather; Miller, Patricia A; Finestone, Hillel; DePaul, Vincent; Harris, Jocelyn E; Velikonja, Diana

    2016-10-06

    Despite increasing evidence for the effectiveness of virtual reality (VR)-based therapy in stroke rehabilitation, few knowledge translation (KT) resources exist to support clinical integration. KT interventions addressing known barriers and facilitators to VR use are required. When environmental barriers to VR integration are less amenable to change, KT interventions can target modifiable barriers related to therapist knowledge and skills. A multi-faceted KT intervention was designed and implemented to support physical and occupational therapists in two stroke rehabilitation units in acquiring proficiency with use of the Interactive Exercise Rehabilitation System (IREX; GestureTek). The KT intervention consisted of interactive e-learning modules, hands-on workshops and experiential practice. Evaluation included the Assessing Determinants of Prospective Take Up of Virtual Reality (ADOPT-VR) Instrument and self-report confidence ratings of knowledge and skills pre- and post-study. Usability of the IREX was measured with the System Usability Scale (SUS). A focus group gathered therapist experiences. Frequency of IREX use was recorded for 6 months post-study. Eleven therapists delivered a total of 107 sessions of VR-based therapy to 34 clients with stroke. On the ADOPT-VR, significant pre-post improvements in therapist perceived behavioral control (p = 0.003), self-efficacy (p = 0.005) and facilitating conditions (p =0.019) related to VR use were observed. Therapist intention to use VR did not change. Knowledge and skills improved significantly following e-learning completion (p = 0.001) and was sustained 6 months post-study. Below average perceived usability of the IREX (19 th percentile) was reported. Lack of time was the most frequently reported barrier to VR use. A decrease in frequency of perceived barriers to VR use was not significant (p = 0.159). Two therapists used the IREX sparingly in the 6 months following the study. Therapists reported

  15. Virtual reality games for rehabilitation of people with stroke: perspectives from the users.

    Science.gov (United States)

    Lewis, Gwyn N; Woods, Claire; Rosie, Juliet A; McPherson, Kathryn M

    2011-01-01

    PURPOSE. The purpose of this study is to evaluate the feasibility and users' perspectives of a novel virtual reality (VR) game-based rehabilitation intervention for people with stroke. METHOD. Six people with upper limb hemiplegia participated in a 6-week intervention that involved VR games. A series of eight progressively complex games was developed that required participants to navigate a submarine in a virtual ocean environment. Movement of the submarine was directed by forces applied to an arm interface by the affected limb. Outcome measures included assessments of arm function, questionnaires evaluating the intervention and a semi-structured interview concerning the participants' opinion of the intervention. RESULTS. All participants improved their performance on the games, although there were limited changes in clinical measures of arm function. All participants reported that they enjoyed the intervention with a wide range of overall perceptions of the experience of using VR. Three themes emerging from the interview data were: stretching myself, purpose and expectations of the intervention and future improvements. CONCLUSIONS. Participants found that taking part in this pilot study was enjoyable and challenging. Participants' feedback suggested that the games may be motivating and engaging for future users and have provided a basis for further development of the intervention.

  16. NASA Virtual Institutes: International Bridges for Space Exploration

    Science.gov (United States)

    Schmidt, Gregory K.

    2016-01-01

    NASA created the first virtual institute, the NASA Astrobiology Institute (NAI), in 2009 with an aim toward bringing together geographically disparate and multidisciplinary teams toward the goal of answering broad questions in the then-new discipline of astrobiology. With the success of the virtual institute model, NASA then created the NASA Lunar Science Institute (NLSI) in 2008 to address questions of science and human exploration of the Moon, and then the NASA Aeronautics Research Institute (NARI) in 2012 which addresses key questions in the development of aeronautics technologies. With the broadening of NASA's human exploration targets to include Near Earth Asteroids and the moons of Mars as well as the Moon, the NLSI morphed into the Solar System Exploration Research Virtual Institute (SSERVI) in 2012. SSERVI funds domestic research teams to address broad questions at the intersection of science and human exploration, with the underlying principle that science enables human exploration, and human exploration enables science. Nine domestic teams were funded in 2014 for a five-year period to address a variety of different topics, and nine international partners (with more to come) also work with the U.S. teams on a variety of topics of mutual interest. The result is a robust and productive research infrastructure that is not only scientifically productive but can respond to strategic topics of domestic and international interest, and which develops a new generation of researchers. This is all accomplished with the aid of virtual collaboration technologies which enable scientific research at a distance. The virtual institute model is widely applicable to a range of space science and exploration problems.

  17. Effect of Virtual Reality on Postural and Balance Control in Patients with Stroke: A Systematic Literature Review

    Directory of Open Access Journals (Sweden)

    Ling Chen

    2016-01-01

    Full Text Available Objective. To critically evaluate the studies that were conducted over the past 10 years and to assess the impact of virtual reality on static and dynamic balance control in the stroke population. Method. A systematic review of randomized controlled trials published between January 2006 and December 2015 was conducted. Databases searched were PubMed, Scopus, and Web of Science. Studies must have involved adult patients with stroke during acute, subacute, or chronic phase. All included studies must have assessed the impact of virtual reality programme on either static or dynamic balance ability and compared it with a control group. The Physiotherapy Evidence Database (PEDro scale was used to assess the methodological quality of the included studies. Results. Nine studies were included in this systematic review. The PEDro scores ranged from 4 to 9 points. All studies, except one, showed significant improvement in static or dynamic balance outcomes group. Conclusions. This review provided moderate evidence to support the fact that virtual reality training is an effective adjunct to standard rehabilitation programme to improve balance for patients with chronic stroke. The effect of VR training in balance recovery is less clear in patients with acute or subacute stroke. Further research is required to investigate the optimum training intensity and frequency to achieve the desired outcome.

  18. Effect of Virtual Reality on Postural and Balance Control in Patients with Stroke: A Systematic Literature Review.

    Science.gov (United States)

    Chen, Ling; Lo, Wai Leung Ambrose; Mao, Yu Rong; Ding, Ming Hui; Lin, Qiang; Li, Hai; Zhao, Jiang Li; Xu, Zhi Qin; Bian, Rui Hao; Huang, Dong Feng

    2016-01-01

    Objective . To critically evaluate the studies that were conducted over the past 10 years and to assess the impact of virtual reality on static and dynamic balance control in the stroke population. Method . A systematic review of randomized controlled trials published between January 2006 and December 2015 was conducted. Databases searched were PubMed, Scopus, and Web of Science. Studies must have involved adult patients with stroke during acute, subacute, or chronic phase. All included studies must have assessed the impact of virtual reality programme on either static or dynamic balance ability and compared it with a control group. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of the included studies. Results . Nine studies were included in this systematic review. The PEDro scores ranged from 4 to 9 points. All studies, except one, showed significant improvement in static or dynamic balance outcomes group. Conclusions . This review provided moderate evidence to support the fact that virtual reality training is an effective adjunct to standard rehabilitation programme to improve balance for patients with chronic stroke. The effect of VR training in balance recovery is less clear in patients with acute or subacute stroke. Further research is required to investigate the optimum training intensity and frequency to achieve the desired outcome.

  19. Effects of a virtual reality-based exercise program on functional recovery in stroke patients: part 1.

    Science.gov (United States)

    Lee, Kyoung-Hee

    2015-06-01

    This study aimed to determine the effects of a virtual reality exercise program using the Interactive Rehabilitation and Exercise System (IREX) on the recovery of motor and cognitive function and the performance of activities of daily living in stroke patients. [Subjects] The study enrolled 10 patients diagnosed with stroke who received occupational therapy at the Department of Rehabilitation Medicine of Hospital A between January and March 2014. [Methods] The patients took part in the virtual reality exercise program for 30 minutes each day, three times per week, for 4 weeks. Then, the patients were re-evaluated to determine changes in upper extremity function, cognitive function, and performance of activities of daily living 4 weeks after the baseline assessment. [Results] In the experimental group, there were significant differences in the Korea-Mini Mental Status Evaluation, Korean version of the modified Barthel index, and Fugl-Meyer assessment scores between the baseline and endpoint. [Conclusion] The virtual reality exercise program was effective for restoring function in stroke patients. Further studies should develop systematic protocols for rehabilitation training with a virtual reality exercise program.

  20. Improvement in balance using a virtual reality-based stepping exercise: a randomized controlled trial involving individuals with chronic stroke.

    Science.gov (United States)

    Lloréns, Roberto; Gil-Gómez, José-Antonio; Alcañiz, Mariano; Colomer, Carolina; Noé, Enrique

    2015-03-01

    To study the clinical effectiveness and the usability of a virtual reality-based intervention compared with conventional physical therapy in the balance recovery of individuals with chronic stroke. Randomized controlled trial. Outpatient neurorehabilitation unit. A total of 20 individuals with chronic stroke. The intervention consisted of 20 one-hour sessions, five sessions per week. The experimental group combined 30 minutes with the virtual reality-based intervention with 30 minutes of conventional training. The control group underwent one hour conventional therapy. Balance performance was assessed at the beginning and at the end of the trial using the Berg Balance Scale, the balance and gait subscales of the Tinetti Performance-Oriented Mobility Assessment, the Brunel Balance Assessment, and the 10-m Walking Test. Subjective data of the virtual reality-based intervention were collected from the experimental group, with a feedback questionnaire at the end of the trial. The results revealed a significant group-by-time interaction in the scores of the Berg Balance Scale (p Virtual reality interventions can be an effective resource to enhance the improvement of balance in individuals with chronic stroke. © The Author(s) 2014.

  1. Increasing upper limb training intensity in chronic stroke using embodied virtual reality: a pilot study.

    Science.gov (United States)

    Perez-Marcos, Daniel; Chevalley, Odile; Schmidlin, Thomas; Garipelli, Gangadhar; Serino, Andrea; Vuadens, Philippe; Tadi, Tej; Blanke, Olaf; Millán, José D R

    2017-11-17

    Technology-mediated neurorehabilitation is suggested to enhance training intensity and therefore functional gains. Here, we used a novel virtual reality (VR) system for task-specific upper extremity training after stroke. The system offers interactive exercises integrating motor priming techniques and embodied visuomotor feedback. In this pilot study, we examined (i) rehabilitation dose and training intensity, (ii) functional improvements, and (iii) safety and tolerance when exposed to intensive VR rehabilitation. Ten outpatient stroke survivors with chronic (>6 months) upper extremity paresis participated in a ten-session VR-based upper limb rehabilitation program (2 sessions/week). All participants completed all sessions of the treatment. In total, they received a median of 403 min of upper limb therapy, with 290 min of effective training. Within that time, participants performed a median of 4713 goal-directed movements. Importantly, training intensity increased progressively across sessions from 13.2 to 17.3 movements per minute. Clinical measures show that despite being in the chronic phase, where recovery potential is thought to be limited, participants showed a median improvement rate of 5.3% in motor function (Fugl-Meyer Assessment for Upper Extremity; FMA-UE) post intervention compared to baseline, and of 15.4% at one-month follow-up. For three of them, this improvement was clinically significant. A significant improvement in shoulder active range of motion (AROM) was also observed at follow-up. Participants reported very low levels of pain, stress and fatigue following each session of training, indicating that the intensive VR intervention was well tolerated. No severe adverse events were reported. All participants expressed their interest in continuing the intervention at the hospital or even at home, suggesting high levels of adherence and motivation for the provided intervention. This pilot study showed how a dedicated VR system could deliver high

  2. Stroke

    Science.gov (United States)

    ... doctor Preventing falls Stroke - discharge Swallowing problems Images Brain Carotid stenosis, x-ray of the left artery Carotid stenosis, x-ray of the right artery Stroke Brainstem function Cerebellum - function Circle of Willis Left cerebral hemisphere - ...

  3. Internal Carotid Artery Stenosis and Collateral Recruitment in Stroke Patients.

    Science.gov (United States)

    Dankbaar, Jan W; Kerckhoffs, Kelly G P; Horsch, Alexander D; van der Schaaf, Irene C; Kappelle, L Jaap; Velthuis, Birgitta K

    2017-04-24

    Leptomeningeal collaterals improve outcome in stroke patients. There is great individual variability in their extent. Internal carotid artery (ICA) stenosis may lead to more extensive recruitment of leptomeningeal collaterals. The purpose of this study was to evaluate the association of pre-existing ICA stenosis with leptomeningeal collateral filling visualized with computed tomography perfusion (CTP). From a prospective acute ischemic stroke cohort, patients were included with an M1 middle cerebral artery (MCA) occlusion and absent ipsilateral, extracranial ICA occlusion. ICA stenosis was determined on admission CT angiography (CTA). Leptomeningeal collaterals were graded as good (>50%) or poor (≤50%) collateral filling in the affected MCA territory on CTP-derived vessel images of the admission scan. The association between ipsilateral ICA stenosis ≥70% and extent of collateral filling was analyzed using logistic regression. In a multivariable analysis the odds ratio (OR) of ICA stenosis ≥70% was adjusted for complete circle of Willis, gender and age. We included 188 patients in our analyses, 50 (26.6%) patients were classified as having poor collateral filling and 138 (73.4%) as good. Of the patients 4 with poor collateral filling had an ICA stenosis ≥70% and 14 with good collateral filling. Unadjusted and adjusted ORs of ICA stenosis ≥70% for good collateral filling were 1.30 (0.41-4.15) and 2.67 (0.81-8.77), respectively. Patients with poor collateral filling had a significantly worse outcome (90-day modified Rankin scale 3-6; 80% versus 52%, p = 0.001). No association was found between pre-existing ICA stenosis and extent of CTP derived collateral filling in patients with an M1 occlusion.

  4. Effectiveness of virtual reality using Wii gaming technology in stroke rehabilitation: a pilot randomized clinical trial and proof of principle.

    Science.gov (United States)

    Saposnik, Gustavo; Teasell, Robert; Mamdani, Muhammad; Hall, Judith; McIlroy, William; Cheung, Donna; Thorpe, Kevin E; Cohen, Leonardo G; Bayley, Mark

    2010-07-01

    Hemiparesis resulting in functional limitation of an upper extremity is common among stroke survivors. Although existing evidence suggests that increasing intensity of stroke rehabilitation therapy results in better motor recovery, limited evidence is available on the efficacy of virtual reality for stroke rehabilitation. In this pilot, randomized, single-blinded clinical trial with 2 parallel groups involving stroke patients within 2 months, we compared the feasibility, safety, and efficacy of virtual reality using the Nintendo Wii gaming system (VRWii) versus recreational therapy (playing cards, bingo, or "Jenga") among those receiving standard rehabilitation to evaluate arm motor improvement. The primary feasibility outcome was the total time receiving the intervention. The primary safety outcome was the proportion of patients experiencing intervention-related adverse events during the study period. Efficacy, a secondary outcome measure, was evaluated with the Wolf Motor Function Test, Box and Block Test, and Stroke Impact Scale at 4 weeks after intervention. Overall, 22 of 110 (20%) of screened patients were randomized. The mean age (range) was 61.3 (41 to 83) years. Two participants dropped out after a training session. The interventions were successfully delivered in 9 of 10 participants in the VRWii and 8 of 10 in the recreational therapy arm. The mean total session time was 388 minutes in the recreational therapy group compared with 364 minutes in the VRWii group (P=0.75). There were no serious adverse events in any group. Relative to the recreational therapy group, participants in the VRWii arm had a significant improvement in mean motor function of 7 seconds (Wolf Motor Function Test, 7.4 seconds; 95% CI, -14.5, -0.2) after adjustment for age, baseline functional status (Wolf Motor Function Test), and stroke severity. VRWii gaming technology represents a safe, feasible, and potentially effective alternative to facilitate rehabilitation therapy and promote

  5. Virtual Instrument for Emissions Measurement of Internal Combustion Engines

    Science.gov (United States)

    Pérez, Armando; Montero, Gisela; Coronado, Marcos; García, Conrado; Pérez, Rubén

    2016-01-01

    The gases emissions measurement systems in internal combustion engines are strict and expensive nowadays. For this reason, a virtual instrument was developed to measure the combustion emissions from an internal combustion diesel engine, running with diesel-biodiesel mixtures. This software is called virtual instrument for emissions measurement (VIEM), and it was developed in the platform of LabVIEW 2010® virtual programming. VIEM works with sensors connected to a signal conditioning system, and a data acquisition system is used as interface for a computer in order to measure and monitor in real time the emissions of O2, NO, CO, SO2, and CO2 gases. This paper shows the results of the VIEM programming, the integrated circuits diagrams used for the signal conditioning of sensors, and the sensors characterization of O2, NO, CO, SO2, and CO2. VIEM is a low-cost instrument and is simple and easy to use. Besides, it is scalable, making it flexible and defined by the user. PMID:27034893

  6. Virtual Instrument for Emissions Measurement of Internal Combustion Engines.

    Science.gov (United States)

    Pérez, Armando; Ramos, Rogelio; Montero, Gisela; Coronado, Marcos; García, Conrado; Pérez, Rubén

    2016-01-01

    The gases emissions measurement systems in internal combustion engines are strict and expensive nowadays. For this reason, a virtual instrument was developed to measure the combustion emissions from an internal combustion diesel engine, running with diesel-biodiesel mixtures. This software is called virtual instrument for emissions measurement (VIEM), and it was developed in the platform of LabVIEW 2010® virtual programming. VIEM works with sensors connected to a signal conditioning system, and a data acquisition system is used as interface for a computer in order to measure and monitor in real time the emissions of O2, NO, CO, SO2, and CO2 gases. This paper shows the results of the VIEM programming, the integrated circuits diagrams used for the signal conditioning of sensors, and the sensors characterization of O2, NO, CO, SO2, and CO2. VIEM is a low-cost instrument and is simple and easy to use. Besides, it is scalable, making it flexible and defined by the user.

  7. Inequities in access to inpatient rehabilitation after stroke: an international scoping review.

    Science.gov (United States)

    Lynch, Elizabeth A; Cadilhac, Dominique A; Luker, Julie A; Hillier, Susan L

    2017-12-01

    Background Inequities in accessing inpatient rehabilitation after stroke have been reported in many countries and impact on patient outcomes. Objective To explore variation in international recommendations regarding which patients should receive inpatient rehabilitation after stroke and to describe reported access to rehabilitation. Methods A scoping review was conducted to identify clinical guidelines with recommendations regarding which patients should access inpatient rehabilitation after stroke, and data regarding the proportion of patients accessing stroke rehabilitation. Four bibliographic databases and grey literature were searched. Results Twenty-eight documents were included. Selection criteria for post-acute inpatient rehabilitation were identified for 14 countries or regions and summary data on the proportion of patients receiving inpatient rehabilitation were identified for 14 countries. In Australia, New Zealand, and the United Kingdom, it is recommended that all patients with stroke symptoms should access rehabilitation, whereas guidelines from the United States, Canada, and Europe did not consistently recommend rehabilitation for people with severe stroke. Access to inpatient rehabilitation ranged from 13% in Sweden to 57% in Israel. Differences in availability of early supported discharge/home rehabilitation programs and variations in reporting methods may influence the ability to reliably compare access to rehabilitation between regions. Conclusion Recommendations regarding which patients with moderate and severe strokes should access ongoing rehabilitation are inconsistent. Clinical practice guidelines from different countries regarding post-stroke rehabilitation do not always reflect the evidence regarding the likely benefits to people with stroke. Inequity in access to rehabilitation after stroke is an international issue.

  8. Effects of virtual reality-based training and task-oriented training on balance performance in stroke patients.

    Science.gov (United States)

    Lee, Hyung Young; Kim, You Lim; Lee, Suk Min

    2015-06-01

    [Purpose] This study aimed to investigate the clinical effects of virtual reality-based training and task-oriented training on balance performance in stroke patients. [Subjects and Methods] The subjects were randomly allocated to 2 groups: virtual reality-based training group (n = 12) and task-oriented training group (n = 12). The patients in the virtual reality-based training group used the Nintendo Wii Fit Plus, which provided visual and auditory feedback as well as the movements that enabled shifting of weight to the right and left sides, for 30 min/day, 3 times/week for 6 weeks. The patients in the task-oriented training group practiced additional task-oriented programs for 30 min/day, 3 times/week for 6 weeks. Patients in both groups also underwent conventional physical therapy for 60 min/day, 5 times/week for 6 weeks. [Results] Balance and functional reach test outcomes were examined in both groups. The results showed that the static balance and functional reach test outcomes were significantly higher in the virtual reality-based training group than in the task-oriented training group. [Conclusion] This study suggested that virtual reality-based training might be a more feasible and suitable therapeutic intervention for dynamic balance in stroke patients compared to task-oriented training.

  9. An International Standard Set of Patient-Centered Outcome Measures After Stroke

    NARCIS (Netherlands)

    Salinas, J. (Joel); Sprinkhuizen, S.M. (Sara M.); Ackerson, T. (Teri); Bernhardt, J. (Julie); Davie, C. (Charlie); George, M.G. (Mary G.); Gething, S. (Stephanie); Kelly, A.G. (Adam G.); Lindsay, P. (Patrice); Liu, L. (Liping); Martins, S.C.O. (Sheila C.O.); Morgan, L. (Louise); B. Norrving (Bo); Ribbers, G.M. (Gerard M.); Silver, F.L. (Frank L.); Smith, E.E. (Eric E.); Williams, L.S. (Linda S.); Schwamm, L.H. (Lee H.)

    2015-01-01

    markdownabstract__BACKGROUND AND PURPOSE:__ Value-based health care aims to bring together patients and health systems to maximize the ratio of quality over cost. To enable assessment of healthcare value in stroke management, an international standard set of patient-centered stroke outcome measures

  10. Therapists’ Perspective on Virtual Reality Training in Patients after Stroke: A Qualitative Study Reporting Focus Group Results from Three Hospitals

    OpenAIRE

    Ludwig Schmid; Andrea Glässel; Corina Schuster-Amft

    2016-01-01

    Background. During the past decade, virtual reality (VR) has become a new component in the treatment of patients after stroke. Therefore aims of the study were (a) to get an insight into experiences and expectations of physiotherapists and occupational therapists in using a VR training system and (b) to investigate relevant facilitators, barriers, and risks for implementing VR training in clinical practice. Methods. Three focus groups were conducted with occupational therapists and physiother...

  11. Effects of community-based virtual reality treadmill training on balance ability in patients with chronic stroke.

    Science.gov (United States)

    Kim, Nara; Park, YuHyung; Lee, Byoung-Hee

    2015-03-01

    [Purpose] We aimed to examine the effectiveness of a community-based virtual reality treadmill training (CVRTT) program on static balance abilities in patients with stroke. [Subjects and Methods] Patients (n = 20) who suffered a stroke at least 6 months prior to the study were recruited. All subjects underwent conventional physical therapy for 60 min/day, 5 days/week, for 4 weeks. Additionally, the CVRTT group underwent community-based virtual reality scene exposure combined with treadmill training for 30 min/day, 3 days/week, for 4 weeks, whereas the control group underwent conventional physical therapy, including muscle strengthening, balance training, and indoor and outdoor gait training, for 30 min/day, 3 days/week, for 4 weeks. Outcome measurements included the anteroposterior, mediolateral, and total postural sway path lengths and speed, which were recorded using the Balancia Software on a Wii Fit(™) balance board. [Results] The postural sway speed and anteroposterior and total postural sway path lengths were significantly decreased in the CVRTT group. Overall, the CVRTT group showed significantly greater improvement than the control group. [Conclusions] The present study results can be used to support the use of CVRTT for effectively improving balance in stroke patients. Moreover, we determined that a CVRTT program for stroke patients is both feasible and suitable.

  12. Does the Inclusion of Virtual Reality Games within Conventional Rehabilitation Enhance Balance Retraining after a Recent Episode of Stroke?

    Directory of Open Access Journals (Sweden)

    B. S. Rajaratnam

    2013-01-01

    Full Text Available This randomised controlled and double-blinded pilot study evaluated if interactive virtual reality balance related games integrated within conventional rehabilitation sessions resulted in more superior retraining of dynamic balance compared to CR after stroke. 19 subjects diagnosed with a recent episode of stroke were recruited from a local rehabilitation hospital and randomly assigned to either a control or an experimental group. Subjects in the control groups underwent 60 minutes of conventional rehabilitation while those in the experimental groups underwent 40 minutes of convention rehabilitation and 20 minutes of self-directed virtual reality balanced rehabilitation. Functional Reach Test, Timed Up and Go, Modified Barthel Index, Berg Balance Scale, and Centre of Pressure of subjects in both groups were evaluated before and on completion of the rehabilitation sessions. Results indicate that the inclusion of interactive virtual reality balance related games within conventional rehabilitation can lead to improved functional mobility and balance after a recent episode of stroke without increasing treatment time that requires more health professional manpower.

  13. Four-Stroke, Internal Combustion Engine Performance Modeling

    Science.gov (United States)

    Wagner, Richard C.

    In this thesis, two models of four-stroke, internal combustion engines are created and compared. The first model predicts the intake and exhaust processes using isentropic flow equations augmented by discharge coefficients. The second model predicts the intake and exhaust processes using a compressible, time-accurate, Quasi-One-Dimensional (Q1D) approach. Both models employ the same heat release and reduced-order modeling of the cylinder charge. Both include friction and cylinder loss models so that the predicted performance values can be compared to measurements. The results indicate that the isentropic-based model neglects important fluid mechanics and returns inaccurate results. The Q1D flow model, combined with the reduced-order model of the cylinder charge, is able to capture the dominant intake and exhaust fluid mechanics and produces results that compare well with measurement. Fluid friction, convective heat transfer, piston ring and skirt friction and temperature-varying specific heats in the working fluids are all shown to be significant factors in engine performance predictions. Charge blowby is shown to play a lesser role.

  14. The Efficacy of a Haptic-Enhanced Virtual Reality System for Precision Grasp Acquisition in Stroke Rehabilitation

    Directory of Open Access Journals (Sweden)

    Shih-Ching Yeh

    2017-01-01

    Full Text Available Stroke is a leading cause of long-term disability, and virtual reality- (VR- based stroke rehabilitation is effective in increasing motivation and the functional performance. Although much of the functional reach and grasp capabilities of the upper extremities were regained, the pinch movement remains impaired following stroke. In this study, we developed a haptic-enhanced VR system to simulate haptic pinch tasks to assist the recovery of upper-extremity fine motor function. We recruited 16 adults with stroke to verify the efficacy of this new VR system. Each patient received 30 min VR training sessions 3 times per week for 8 weeks. Outcome measures, Fugl-Meyer assessment (FMA, Test Evaluant les Membres superieurs des Personnes Agees (TEMPA, Wolf motor function test (WMFT, Box and Block test (BBT, and Jamar grip dynamometer, showed statistically significant progress from pretest to posttest and follow-up, indicating that the proposed system effectively promoted fine motor recovery of function. Additionally, our evidence suggests that this system was also effective under certain challenging conditions such as being in the chronic stroke phase or a coside of lesion and dominant hand (nondominant hand impaired. System usability assessment indicated that the participants strongly intended to continue using this VR-based system in rehabilitation.

  15. Combined rTMS and virtual reality brain-computer interface training for motor recovery after stroke

    Science.gov (United States)

    Johnson, N. N.; Carey, J.; Edelman, B. J.; Doud, A.; Grande, A.; Lakshminarayan, K.; He, B.

    2018-02-01

    Objective. Combining repetitive transcranial magnetic stimulation (rTMS) with brain-computer interface (BCI) training can address motor impairment after stroke by down-regulating exaggerated inhibition from the contralesional hemisphere and encouraging ipsilesional activation. The objective was to evaluate the efficacy of combined rTMS  +  BCI, compared to sham rTMS  +  BCI, on motor recovery after stroke in subjects with lasting motor paresis. Approach. Three stroke subjects approximately one year post-stroke participated in three weeks of combined rTMS (real or sham) and BCI, followed by three weeks of BCI alone. Behavioral and electrophysiological differences were evaluated at baseline, after three weeks, and after six weeks of treatment. Main results. Motor improvements were observed in both real rTMS  +  BCI and sham groups, but only the former showed significant alterations in inter-hemispheric inhibition in the desired direction and increased relative ipsilesional cortical activation from fMRI. In addition, significant improvements in BCI performance over time and adequate control of the virtual reality BCI paradigm were observed only in the former group. Significance. When combined, the results highlight the feasibility and efficacy of combined rTMS  +  BCI for motor recovery, demonstrated by increased ipsilesional motor activity and improvements in behavioral function for the real rTMS  +  BCI condition in particular. Our findings also demonstrate the utility of BCI training alone, as shown by behavioral improvements for the sham rTMS  +  BCI condition. This study is the first to evaluate combined rTMS and BCI training for motor rehabilitation and provides a foundation for continued work to evaluate the potential of both rTMS and virtual reality BCI training for motor recovery after stroke.

  16. Improving balance skills in patients who had stroke through virtual reality treadmill training.

    Science.gov (United States)

    Yang, Saiwei; Hwang, Wei-Hsung; Tsai, Yi-Ching; Liu, Fu-Kang; Hsieh, Lin-Fen; Chern, Jen-Suh

    2011-12-01

    The aim of this study was to evaluate the effects of virtual reality (VR) treadmill training on the balance skills of patients who have had a stroke. A total of 14 patients with strokes were recruited and randomly assigned to receive VR treadmill or traditional treadmill training. The outcome measures that were included for the study were center of pressure (COP) sway excursion, COP maximum sway in anterior-posterior direction, COP maximum sway in medial-lateral direction, COP sway area, bilateral limb-loading symmetric index, the sway excursion values for the paretic foot (sway excursion/P), paretic limb stance time (stance time/P), number of steps of the paretic limb (number of steps/P), and contact area of the paretic foot (contact A/P) during quiet stance, sit-to-stand transfer, and level walking. There were no significant improvements in COP-related measures and symmetric index during the quiet stance, either in the VR treadmill or traditional treadmill training group (P > 0.05). However, the difference between groups after training in COP maximum sway in medial-lateral direction during the quiet stance was significant (P = 0.038). Traditional treadmill training failed to improve sit-to-stand performance, whereas VR treadmill training improved symmetric index (P = 0.028) and sway excursion (P = 0.046) significantly during sit-to-stand transfer. The changes of symmetric index between groups were markedly different (P = 0.045). Finally, both groups improved significantly in stance time/P, but only VR treadmill training increased contact A/P (P = 0.034) after training during level walking. The difference between groups during level walking was not significant. Neither traditional treadmill nor VR treadmill training had any effect on balance skill during quiet stance, but VR treadmill training improved balance skill in the medial-lateral direction better than traditional training did. VR treadmill training also improved balance skill during sit-to-stand transfers

  17. Effects of the addition of transcranial direct current stimulation to virtual reality therapy after stroke: a pilot randomized controlled trial.

    Science.gov (United States)

    Viana, R T; Laurentino, G E C; Souza, R J P; Fonseca, J B; Silva Filho, E M; Dias, S N; Teixeira-Salmela, L F; Monte-Silva, K K

    2014-01-01

    Upper limb (UL) impairment is the most common disabling deficit following a stroke. Previous studies have suggested that transcranial direct current stimulation (tDCS) enhances the effect of conventional therapies. This pilot double-blind randomized control trial aimed to determine whether or not tDCS, combined with Wii virtual reality therapy (VRT), would be superior to Wii therapy alone in improving upper limb function and quality of life in chronic stroke individuals. Twenty participants were randomly assigned either to an experimental group that received VRT and tDCS, or a control group that received VRT and sham tDCS. The therapy was delivered over 15 sessions with 13 minutes of active or sham anodal tDCS, and one hour of virtual reality therapy. The outcomes included were determined using the Fugl-Meyer scale, the Wolf motor function test, the modified Ashworth scale (MAS), grip strength, and the stroke specific quality of life scale (SSQOL). Minimal clinically important differences (MCID) were observed when assessing outcome data. Both groups demonstrated gains in all evaluated areas, except for the SSQOL-UL domain. Differences between groups were only observed in wrist spasticity levels in the experimental group, where more than 50% of the participants achieved the MCID. These findings support that tDCS, combined with VRT therapy, should be investigated and clarified further.

  18. Virtual Power Players Internal Negotiation and Management in MASCEM

    DEFF Research Database (Denmark)

    Santos, Gabriel; Pinto, Tiago; Vale, Zita

    2013-01-01

    for the management of coalitions in electricity markets. This approach is tested using the multi-agent market simulator MASCEM (Multi-Agent Simulator of Competitive Electricity Markets), taking advantage of its ability to provide the means to model and simulate Virtual Power Players (VPP). VPPs are represented......Electricity Markets are not only a new reality but an evolving one as the involved players and rules change at a relatively high rate. Multi-agent simulation combined with Artificial Intelligence techniques may result in very helpful sophisticated tools. This paper presents a new methodology...... as coalitions of agents, with the capability of negotiating both in the market and internally, with their members in order to combine and manage their individual specific characteristics and goals, with the strategy and objectives of the VPP itself. A case study using real data from the Iberian Electricity...

  19. Clinical effectiveness of combined virtual reality and robot assisted fine hand motion rehabilitation in subacute stroke patients.

    Science.gov (United States)

    Huang, Xianwei; Naghdy, Fazel; Naghdy, Golshah; Du, Haiping

    2017-07-01

    Robot-assisted therapy is regarded as an effective and reliable method for the delivery of highly repetitive rehabilitation training in restoring motor skills after a stroke. This study focuses on the rehabilitation of fine hand motion skills due to their vital role in performing delicate activities of daily living (ADL) tasks. The proposed rehabilitation system combines an adaptive assist-as-needed (AAN) control algorithm and a Virtual Reality (VR) based rehabilitation gaming system (RGS). The developed system is described and its effectiveness is validated through clinical trials on a group of eight subacute stroke patients for a period of six weeks. The impact of the training is verified through standard clinical evaluation methods and measuring key kinematic parameters. A comparison of the pre- and post-training results indicates that the method proposed in this study can improve fine hand motion rehabilitation training effectiveness.

  20. Virtual reality therapy for adults post-stroke: a systematic review and meta-analysis exploring virtual environments and commercial games in therapy.

    Directory of Open Access Journals (Sweden)

    Keith R Lohse

    Full Text Available The objective of this analysis was to systematically review the evidence for virtual reality (VR therapy in an adult post-stroke population in both custom built virtual environments (VE and commercially available gaming systems (CG.MEDLINE, CINAHL, EMBASE, ERIC, PSYCInfo, DARE, PEDro, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were systematically searched from the earliest available date until April 4, 2013. Controlled trials that compared VR to conventional therapy were included. Population criteria included adults (>18 post-stroke, excluding children, cerebral palsy, and other neurological disorders. Included studies were reported in English. Quality of studies was assessed with the Physiotherapy Evidence Database Scale (PEDro.Twenty-six studies met the inclusion criteria. For body function outcomes, there was a significant benefit of VR therapy compared to conventional therapy controls, G = 0.48, 95% CI = [0.27, 0.70], and no significant difference between VE and CG interventions (P = 0.38. For activity outcomes, there was a significant benefit of VR therapy, G = 0.58, 95% CI = [0.32, 0.85], and no significant difference between VE and CG interventions (P = 0.66. For participation outcomes, the overall effect size was G = 0.56, 95% CI = [0.02, 1.10]. All participation outcomes came from VE studies.VR rehabilitation moderately improves outcomes compared to conventional therapy in adults post-stroke. Current CG interventions have been too few and too small to assess potential benefits of CG. Future research in this area should aim to clearly define conventional therapy, report on participation measures, consider motivational components of therapy, and investigate commercially available systems in larger RCTs.Prospero CRD42013004338.

  1. Virtual reality therapy for adults post-stroke: a systematic review and meta-analysis exploring virtual environments and commercial games in therapy.

    Science.gov (United States)

    Lohse, Keith R; Hilderman, Courtney G E; Cheung, Katharine L; Tatla, Sandy; Van der Loos, H F Machiel

    2014-01-01

    The objective of this analysis was to systematically review the evidence for virtual reality (VR) therapy in an adult post-stroke population in both custom built virtual environments (VE) and commercially available gaming systems (CG). MEDLINE, CINAHL, EMBASE, ERIC, PSYCInfo, DARE, PEDro, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were systematically searched from the earliest available date until April 4, 2013. Controlled trials that compared VR to conventional therapy were included. Population criteria included adults (>18) post-stroke, excluding children, cerebral palsy, and other neurological disorders. Included studies were reported in English. Quality of studies was assessed with the Physiotherapy Evidence Database Scale (PEDro). Twenty-six studies met the inclusion criteria. For body function outcomes, there was a significant benefit of VR therapy compared to conventional therapy controls, G = 0.48, 95% CI = [0.27, 0.70], and no significant difference between VE and CG interventions (P = 0.38). For activity outcomes, there was a significant benefit of VR therapy, G = 0.58, 95% CI = [0.32, 0.85], and no significant difference between VE and CG interventions (P = 0.66). For participation outcomes, the overall effect size was G = 0.56, 95% CI = [0.02, 1.10]. All participation outcomes came from VE studies. VR rehabilitation moderately improves outcomes compared to conventional therapy in adults post-stroke. Current CG interventions have been too few and too small to assess potential benefits of CG. Future research in this area should aim to clearly define conventional therapy, report on participation measures, consider motivational components of therapy, and investigate commercially available systems in larger RCTs. Prospero CRD42013004338.

  2. Virtual-reality balance training with a video-game system improves dynamic balance in chronic stroke patients.

    Science.gov (United States)

    Cho, Ki Hun; Lee, Kyoung Jin; Song, Chang Ho

    2012-09-01

    Stroke is one of the most serious healthcare problems and a major cause of impairment of cognition and physical functions. Virtual rehabilitation approaches to postural control have been used for enhancing functional recovery that may lead to a decrease in the risk of falling. In the present study, we investigated the effects of virtual reality balance training (VRBT) with a balance board game system on balance of chronic stroke patients. Participants were randomly assigned to 2 groups: VRBT group (11 subjects including 3 women, 65.26 years old) and control group (11 subjects including 5 women, 63.13 years old). Both groups participated in a standard rehabilitation program (physical and occupational therapy) for 60 min a day, 5 times a week for 6 weeks. In addition, the VRBT group participated in VRBT for 30 min a day, 3 times a week for 6 weeks. Static balance (postural sway velocity with eyes open or closed) was evaluated with the posturography. Dynamic balance was evaluated with the Berg Balance Scale (BBS) and Timed Up and Go test (TUG) that measures balance and mobility in dynamic balance. There was greater improvement on BBS (4.00 vs. 2.81 scores) and TUG (-1.33 vs. -0.52 sec) in the VRBT group compared with the control group (P < 0.05), but not on static balance in both groups. In conclusion, we demonstrate a significant improvement in dynamic balance in chronic stroke patients with VRBT. VRBT is feasible and suitable for chronic stroke patients with balance deficit in clinical settings.

  3. Combined Cognitive-Motor Rehabilitation in Virtual Reality Improves Motor Outcomes in Chronic Stroke – A Pilot Study

    Directory of Open Access Journals (Sweden)

    Ana L. Faria

    2018-05-01

    Full Text Available Stroke is one of the most common causes of acquired disability, leaving numerous adults with cognitive and motor impairments, and affecting patients’ capability to live independently. Virtual Reality (VR based methods for stroke rehabilitation have mainly focused on motor rehabilitation but there is increasing interest toward the integration of cognitive training for providing more effective solutions. Here we investigate the feasibility for stroke recovery of a virtual cognitive-motor task, the Reh@Task, which combines adapted arm reaching, and attention and memory training. 24 participants in the chronic stage of stroke, with cognitive and motor deficits, were allocated to one of two groups (VR, Control. Both groups were enrolled in conventional occupational therapy, which mostly involves motor training. Additionally, the VR group underwent training with the Reh@Task and the control group performed time-matched conventional occupational therapy. Motor and cognitive competences were assessed at baseline, end of treatment (1 month and at a 1-month follow-up through the Montreal Cognitive Assessment, Single Letter Cancelation, Digit Cancelation, Bells Test, Fugl-Meyer Assessment Test, Chedoke Arm and Hand Activity Inventory, Modified Ashworth Scale, and Barthel Index. Our results show that both groups improved in motor function over time, but the Reh@Task group displayed significantly higher between-group outcomes in the arm subpart of the Fugl-Meyer Assessment Test. Improvements in cognitive function were significant and similar in both groups. Overall, these results are supportive of the viability of VR tools that combine motor and cognitive training, such as the Reh@Task. Trial Registration: This trial was not registered because it is a small clinical study that addresses the feasibility of a prototype device.

  4. Training finger individuation with a mechatronic-virtual reality system leads to improved fine motor control post-stroke.

    Science.gov (United States)

    Thielbar, Kelly O; Lord, Thomas J; Fischer, Heidi C; Lazzaro, Emily C; Barth, Kristin C; Stoykov, Mary E; Triandafilou, Kristen M; Kamper, Derek G

    2014-12-26

    Dexterous manipulation of the hand, one of the features of human motor control, is often compromised after stroke, to the detriment of basic functions. Despite the importance of independent movement of the digits to activities of daily living, relatively few studies have assessed the impact of specifically targeting individuated movements of the digits on hand rehabilitation. The purpose of this study was to investigate the impact of such finger individuation training, by means of a novel mechatronic-virtual reality system, on fine motor control after stroke. An actuated virtual keypad (AVK) system was developed in which the impaired hand controls a virtual hand playing a set of keys. Creation of individuated digit movements is assisted by a pneumatically actuated glove, the PneuGlove. A study examining efficacy of the AVK system was subsequently performed. Participants had chronic, moderate hand impairment resulting from a single stroke incurred at least 6 months prior. Each subject underwent 18 hour-long sessions of extensive therapy (3x per week for 6 weeks) targeted at finger individuation. Subjects were randomly divided into two groups: the first group (Keypad: N = 7) utilized the AVK system while the other group (OT: N = 7) received a similarly intensive dose of occupational therapy; both groups worked directly with a licensed occupational therapist. Outcome measures such as the Jebsen-Taylor Hand Function Test (JTHFT), Action research Arm Test (ARAT), Fugl-Meyer Upper Extremity Motor Assessment/Hand subcomponent (FMUE/FMH), grip and pinch strengths were collected at baseline, post-treatment and one-month post-treatment. While both groups exhibited some signs of change after the training sessions, only the Keypad group displayed statistically significant improvement both for measures of impairment (FMH: p = 0.048) and measures of task performance (JTHFT: p = 0.021). Additionally, the finger individuation index - a measure of finger

  5. Does Virtual Reality-based Kinect Dance Training Paradigm Improve Autonomic Nervous System Modulation in Individuals with Chronic Stroke?

    Science.gov (United States)

    Sampaio, Luciana Maria Malosá; Subramaniam, Savitha; Arena, Ross; Bhatt, Tanvi

    2016-10-01

    Physical inactivity and low resting heart rate variability (HRV) are associated with an increased cardiovascular deconditioning, risk of secondary stroke and mortality. Aerobic dance is a multidimensional physical activity and recent research supports its application as a valid alternative cardiovascular training. Furthermore, technological advances have facilitated the emergence of new approaches for exercise training holding promise, especially those methods that integrate rehabilitation with virtual gaming. The purpose of this study was to evaluate cardiac autonomic modulation in individuals with chronic stroke post-training using a virtual reality - based aerobic dance training paradigm. Eleven community-dwelling individuals with hemiparetic stroke [61.7( ± 4.3) years] received a virtual reality-based dance paradigm for 6 weeks using the commercially available Kinect dance video game "Just Dance 3." The training was delivered in a high-intensity tapering method with the first two weeks consisting of 5 sessions/week, next two weeks of 3 sessions/week and last two weeks of 2 sessions/week, with a total of 20 sessions. Data obtained for HRV analysis pre- and post-intervention consists of HRV for ten minutes in (1) supine resting position; (2) quiet standing. High-frequency (HF) power measures as indicators of cardiac parasympathetic activity, low-frequency (LF) power of parasympathetic-sympathetic balance and LF/HF of sympatho-vagal balance were calculated. YMCA submaximal cycle Ergometer test was used to acquire VO 2 max pre- and post-intervention. Changes in physical activity during dance training were assessed using Omran HJ-321 Tri-Axis Pedometer. After training, participants demonstrated a significant improvement in autonomic modulation in the supine position, indicating an improvement in LF=48.4 ( ± 20.1) to 40.3 ( ± 8.0), p =0.03; HF=51.5 ( ± 19) to 59.7 ( ± 8), p = 0.02 and LF/HF=1.6 ( ± 1.9) to 0.8 ( ± 0.26), p =0.05]. Post-training the

  6. International Virtual Observatory System for Water Resources Information

    Science.gov (United States)

    Leinenweber, Lewis; Bermudez, Luis

    2013-04-01

    Sharing, accessing, and integrating hydrologic and climatic data have been identified as a critical need for some time. The current state of data portals, standards, technologies, activities, and expertise can be leverage to develop an initial operational capability for a virtual observatory system. This system will allow to link observations data with stream networks and models, and to solve semantic inconsistencies among communities. Prototyping a virtual observatory system is an inter-disciplinary, inter-agency and international endeavor. The Open Geospatial Consortium (OGC) within the OGC Interoperability Program provides the process and expertise to run such collaborative effort. The OGC serves as a global forum for the collaboration of developers and users of spatial data products and services, and to advance the development of international standards for geospatial interoperability. The project coordinated by OGC that is advancing an international virtual observatory system for water resources information is called Climatology-Hydrology Information Sharing Pilot, Phase 1 (CHISP-1). It includes observations and forecasts in the U.S. and Canada levering current networks and capabilities. It is designed to support the following use cases: 1) Hydrologic modeling for historical and near-future stream flow and groundwater conditions. Requires the integration of trans-boundary stream flow and groundwater well data, as well as national river networks (US NHD and Canada NHN) from multiple agencies. Emphasis will be on time series data and real-time flood monitoring. 2) Modeling and assessment of nutrient load into the lakes. Requires accessing water-quality data from multiple agencies and integrating with stream flow information for calculating loads. Emphasis on discrete sampled water quality observations, linking those to specific NHD stream reaches and catchments, and additional metadata for sampled data. The key objectives of these use cases are: 1) To link

  7. International Practice in Care Provision for Post-stroke Visual Impairment.

    Science.gov (United States)

    Rowe, Fiona J

    2017-09-01

    This study sought to explore the practice of orthoptists internationally in care provision for poststroke visual impairment. Survey questions were developed and piloted with clinicians, academics, and users. Questions addressed types of visual problems, how these were identified, treated, and followed up, care pathways in use, links with other professions, and referral options. The survey was approved by the institutional ethical committee. The survey was accessed via a web link that was circulated through the International Orthoptic Association member professional organisations to orthoptists. Completed electronic surveys were obtained from 299 individuals. About one-third (35.5%) of orthoptists saw patients within 2 weeks of stroke onset and over half (55.5%) by 1 month post stroke. Stroke survivors were routinely assessed by 87%; over three-quarters in eye clinics. Screening tools were used by 11%. Validated tests were used for assessment of visual acuity (76.5%), visual field (68.2%), eye movement (80.9%), binocular vision (77.9%), and visual function (55.8%). Visual problems suspected by family or professionals were high (86.6%). Typical overall follow-up period of vision care was less than 3 months. Designated care pathways for stroke survivors with visual problems were used by 56.9% of orthoptists. Information on visual impairment was provided by 85.9% of orthoptists. In international orthoptic practice, there is general agreement on assessment and management of visual impairment in stroke populations. More than half of orthoptists reported seeing stroke survivors within 1 month of the stroke onset, typically in eye clinics. There was a high use of validated tests of visual acuity, visual fields, ocular motility, and binocular vision. Similarly there was high use of established treatment options including prisms, occlusion, compensatory strategies, and oculomotor training, appropriately targeted at specific types of visual conditions/symptoms. This

  8. Effects of Virtual Reality Training using Xbox Kinect on Motor Function in Stroke Survivors: A Preliminary Study.

    Science.gov (United States)

    Park, Dae-Sung; Lee, Do-Gyun; Lee, Kyeongbong; Lee, GyuChang

    2017-10-01

    Although the Kinect gaming system (Microsoft Corp, Redmond, WA) has been shown to be of therapeutic benefit in rehabilitation, the applicability of Kinect-based virtual reality (VR) training to improve motor function following a stroke has not been investigated. This study aimed to investigate the effects of VR training, using the Xbox Kinect-based game system, on the motor recovery of patients with chronic hemiplegic stroke. This was a randomized controlled trial. Twenty patients with hemiplegic stroke were randomly assigned to either the intervention group or the control group. Participants in the intervention group (n = 10) received 30 minutes of conventional physical therapy plus 30 minutes of VR training using Xbox Kinect-based games, and those in the control group (n = 10) received 30 minutes of conventional physical therapy only. All interventions consisted of daily sessions for a 6-week period. All measurements using Fugl-Meyer Assessment (FMA-LE), the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), and the 10-meter Walk Test (10mWT) were performed at baseline and at the end of the 6 weeks. The scores on the FMA-LE, BBS, TUG, and 10mWT improved significantly from baseline to post intervention in both the intervention and the control groups after training. The pre-to-post difference scores on BBS, TUG, and 10mWT for the intervention group were significantly more improved than those for the control group (P <.05). Evidence from the present study supports the use of additional VR training with the Xbox Kinect gaming system as an effective therapeutic approach for improving motor function during stroke rehabilitation. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  9. Toward Optimization of Gaze-Controlled Human-Computer Interaction: Application to Hindi Virtual Keyboard for Stroke Patients.

    Science.gov (United States)

    Meena, Yogesh Kumar; Cecotti, Hubert; Wong-Lin, Kongfatt; Dutta, Ashish; Prasad, Girijesh

    2018-04-01

    Virtual keyboard applications and alternative communication devices provide new means of communication to assist disabled people. To date, virtual keyboard optimization schemes based on script-specific information, along with multimodal input access facility, are limited. In this paper, we propose a novel method for optimizing the position of the displayed items for gaze-controlled tree-based menu selection systems by considering a combination of letter frequency and command selection time. The optimized graphical user interface layout has been designed for a Hindi language virtual keyboard based on a menu wherein 10 commands provide access to type 88 different characters, along with additional text editing commands. The system can be controlled in two different modes: eye-tracking alone and eye-tracking with an access soft-switch. Five different keyboard layouts have been presented and evaluated with ten healthy participants. Furthermore, the two best performing keyboard layouts have been evaluated with eye-tracking alone on ten stroke patients. The overall performance analysis demonstrated significantly superior typing performance, high usability (87% SUS score), and low workload (NASA TLX with 17 scores) for the letter frequency and time-based organization with script specific arrangement design. This paper represents the first optimized gaze-controlled Hindi virtual keyboard, which can be extended to other languages.

  10. Leap Motion-based virtual reality training for improving motor functional recovery of upper limbs and neural reorganization in subacute stroke patients

    Directory of Open Access Journals (Sweden)

    Zun-rong Wang

    2017-01-01

    Full Text Available Virtual reality is nowadays used to facilitate motor recovery in stroke patients. Most virtual reality studies have involved chronic stroke patients; however, brain plasticity remains good in acute and subacute patients. Most virtual reality systems are only applicable to the proximal upper limbs (arms because of the limitations of their capture systems. Nevertheless, the functional recovery of an affected hand is most difficult in the case of hemiparesis rehabilitation after a stroke. The recently developed Leap Motion controller can track the fine movements of both hands and fingers. Therefore, the present study explored the effects of a Leap Motion-based virtual reality system on subacute stroke. Twenty-six subacute stroke patients were assigned to an experimental group that received virtual reality training along with conventional occupational rehabilitation, and a control group that only received conventional rehabilitation. The Wolf motor function test (WMFT was used to assess the motor function of the affected upper limb; functional magnetic resonance imaging was used to measure the cortical activation. After four weeks of treatment, the motor functions of the affected upper limbs were significantly improved in all the patients, with the improvement in the experimental group being significantly better than in the control group. The action performance time in the WMFT significantly decreased in the experimental group. Furthermore, the activation intensity and the laterality index of the contralateral primary sensorimotor cortex increased in both the experimental and control groups. These results confirmed that Leap Motion-based virtual reality training was a promising and feasible supplementary rehabilitation intervention, could facilitate the recovery of motor functions in subacute stroke patients. The study has been registered in the Chinese Clinical Trial Registry (registration number: ChiCTR-OCH-12002238.

  11. Leap Motion-based virtual reality training for improving motor functional recovery of upper limbs and neural reorganization in subacute stroke patients

    Science.gov (United States)

    Wang, Zun-rong; Wang, Ping; Xing, Liang; Mei, Li-ping; Zhao, Jun; Zhang, Tong

    2017-01-01

    Virtual reality is nowadays used to facilitate motor recovery in stroke patients. Most virtual reality studies have involved chronic stroke patients; however, brain plasticity remains good in acute and subacute patients. Most virtual reality systems are only applicable to the proximal upper limbs (arms) because of the limitations of their capture systems. Nevertheless, the functional recovery of an affected hand is most difficult in the case of hemiparesis rehabilitation after a stroke. The recently developed Leap Motion controller can track the fine movements of both hands and fingers. Therefore, the present study explored the effects of a Leap Motion-based virtual reality system on subacute stroke. Twenty-six subacute stroke patients were assigned to an experimental group that received virtual reality training along with conventional occupational rehabilitation, and a control group that only received conventional rehabilitation. The Wolf motor function test (WMFT) was used to assess the motor function of the affected upper limb; functional magnetic resonance imaging was used to measure the cortical activation. After four weeks of treatment, the motor functions of the affected upper limbs were significantly improved in all the patients, with the improvement in the experimental group being significantly better than in the control group. The action performance time in the WMFT significantly decreased in the experimental group. Furthermore, the activation intensity and the laterality index of the contralateral primary sensorimotor cortex increased in both the experimental and control groups. These results confirmed that Leap Motion-based virtual reality training was a promising and feasible supplementary rehabilitation intervention, could facilitate the recovery of motor functions in subacute stroke patients. The study has been registered in the Chinese Clinical Trial Registry (registration number: ChiCTR-OCH-12002238). PMID:29239328

  12. Leap Motion-based virtual reality training for improving motor functional recovery of upper limbs and neural reorganization in subacute stroke patients.

    Science.gov (United States)

    Wang, Zun-Rong; Wang, Ping; Xing, Liang; Mei, Li-Ping; Zhao, Jun; Zhang, Tong

    2017-11-01

    Virtual reality is nowadays used to facilitate motor recovery in stroke patients. Most virtual reality studies have involved chronic stroke patients; however, brain plasticity remains good in acute and subacute patients. Most virtual reality systems are only applicable to the proximal upper limbs (arms) because of the limitations of their capture systems. Nevertheless, the functional recovery of an affected hand is most difficult in the case of hemiparesis rehabilitation after a stroke. The recently developed Leap Motion controller can track the fine movements of both hands and fingers. Therefore, the present study explored the effects of a Leap Motion-based virtual reality system on subacute stroke. Twenty-six subacute stroke patients were assigned to an experimental group that received virtual reality training along with conventional occupational rehabilitation, and a control group that only received conventional rehabilitation. The Wolf motor function test (WMFT) was used to assess the motor function of the affected upper limb; functional magnetic resonance imaging was used to measure the cortical activation. After four weeks of treatment, the motor functions of the affected upper limbs were significantly improved in all the patients, with the improvement in the experimental group being significantly better than in the control group. The action performance time in the WMFT significantly decreased in the experimental group. Furthermore, the activation intensity and the laterality index of the contralateral primary sensorimotor cortex increased in both the experimental and control groups. These results confirmed that Leap Motion-based virtual reality training was a promising and feasible supplementary rehabilitation intervention, could facilitate the recovery of motor functions in subacute stroke patients. The study has been registered in the Chinese Clinical Trial Registry (registration number: ChiCTR-OCH-12002238).

  13. Benefits of virtual reality based cognitive rehabilitation through simulated activities of daily living: a randomized controlled trial with stroke patients.

    Science.gov (United States)

    Faria, Ana Lúcia; Andrade, Andreia; Soares, Luísa; I Badia, Sergi Bermúdez

    2016-11-02

    Stroke is one of the most common causes of acquired disability, leaving numerous adults with cognitive and motor impairments, and affecting patients' capability to live independently. There is substancial evidence on post-stroke cognitive rehabilitation benefits, but its implementation is generally limited by the use of paper-and-pencil methods, insufficient personalization, and suboptimal intensity. Virtual reality tools have shown potential for improving cognitive rehabilitation by supporting carefully personalized, ecologically valid tasks through accessible technologies. Notwithstanding important progress in VR-based cognitive rehabilitation systems, specially with Activities of Daily Living (ADL's) simulations, there is still a need of more clinical trials for its validation. In this work we present a one-month randomized controlled trial with 18 stroke in and outpatients from two rehabilitation units: 9 performing a VR-based intervention and 9 performing conventional rehabilitation. The VR-based intervention involved a virtual simulation of a city - Reh@City - where memory, attention, visuo-spatial abilities and executive functions tasks are integrated in the performance of several daily routines. The intervention had levels of difficulty progression through a method of fading cues. There was a pre and post-intervention assessment in both groups with the Addenbrooke Cognitive Examination (primary outcome) and the Trail Making Test A and B, Picture Arrangement from WAIS III and Stroke Impact Scale 3.0 (secondary outcomes). A within groups analysis revealed significant improvements in global cognitive functioning, attention, memory, visuo-spatial abilities, executive functions, emotion and overall recovery in the VR group. The control group only improved in self-reported memory and social participation. A between groups analysis, showed significantly greater improvements in global cognitive functioning, attention and executive functions when comparing VR to

  14. Considerations in the efficacy and effectiveness of virtual reality interventions for stroke rehabilitation: moving the field forward.

    Science.gov (United States)

    Proffitt, Rachel; Lange, Belinda

    2015-03-01

    In the past 2 decades, researchers have demonstrated the potential for virtual reality (VR) technologies to provide engaging and motivating environments for stroke rehabilitation interventions. Much of the research has been focused on the exploratory phase, and jumps to intervention efficacy trials and scale-up evaluation have been made with limited understanding of the active ingredients in a VR intervention for stroke. The rapid pace of technology development is an additional challenge for this emerging field, providing a moving target for researchers developing and evaluating potential VR technologies. Recent advances in customized games and cutting-edge technology used for VR are beginning to allow for researchers to understand and control aspects of the intervention related to motivation, engagement, and motor control and learning. This article argues for researchers to take a progressive, step-wise approach through the stages of intervention development using evidence-based principles, take advantage of the data that can be obtained, and utilize measurement tools to design effective VR interventions for stroke rehabilitation that can be assessed through carefully designed efficacy and effectiveness trials. This article is motivated by the recent calls in the field of rehabilitation clinical trials research for carefully structured clinical trials that have progressed through the phases of research. © 2015 American Physical Therapy Association.

  15. Observer reliability of CT angiography in the assessment of acute ischaemic stroke: data from the Third International Stroke Trial

    Energy Technology Data Exchange (ETDEWEB)

    Mair, Grant; Farrall, Andrew J.; Sellar, Robin J.; Mollison, Daisy; Sakka, Eleni; Palmer, Jeb; Wardlaw, Joanna M. [University of Edinburgh, Western General Hospital, Division of Neuroimaging Sciences, Edinburgh (United Kingdom); Kummer, Ruediger von [Dresden University Stroke Centre, University Hospital, Department of Neuroradiology, Dresden (Germany); Adami, Alessandro [Sacro Cuore-Don Calabria Hospital, Stroke Center, Department of Neurology, Negrar (Italy); White, Philip M. [Stroke Research Group, Newcastle upon Tyne (United Kingdom); Adams, Matthew E. [National Hospital for Neurology and Neurosurgery, Department of Neuroradiology, London (United Kingdom); Yan, Bernard [Royal Melbourne Hospital, Neurovascular Research Group, Parkville (Australia); Demchuk, Andrew M. [Calgary Stroke Program, Department of Clinical Neurosciences, Calgary (Canada); Ramaswamy, Rajesh; Rodrigues, Mark A.; Samji, Karim; Baird, Andrew J. [Royal Infirmary of Edinburgh, Department of Radiology, Edinburgh (United Kingdom); Boyd, Elena V. [Northwick Park Hospital, Department of Radiology, Harrow (United Kingdom); Cohen, Geoff; Perry, David; Sandercock, Peter A.G. [University of Edinburgh, Western General Hospital, Division of Clinical Neurosciences, Edinburgh (United Kingdom); Lindley, Richard [University of Sydney, Westmead Hospital Clinical School and The George Institute for Global Health, Sydney (Australia); Collaboration: The IST-3 Collaborative Group

    2014-10-07

    CT angiography (CTA) is often used for assessing patients with acute ischaemic stroke. Only limited observer reliability data exist. We tested inter- and intra-observer reliability for the assessment of CTA in acute ischaemic stroke. We selected 15 cases from the Third International Stroke Trial (IST-3, ISRCTN25765518) with various degrees of arterial obstruction in different intracranial locations on CTA. To assess inter-observer reliability, seven members of the IST-3 expert image reading panel (>5 years experience reading CTA) and seven radiology trainees (<2 years experience) rated all 15 scans independently and blind to clinical data for: presence (versus absence) of any intracranial arterial abnormality (stenosis or occlusion), severity of arterial abnormality using relevant scales (IST-3 angiography score, Thrombolysis in Cerebral Infarction (TICI) score, Clot Burden Score), collateral supply and visibility of a perfusion defect on CTA source images (CTA-SI). Intra-observer reliability was assessed using independently repeated expert panel scan ratings. We assessed observer agreement with Krippendorff's-alpha (K-alpha). Among experienced observers, inter-observer agreement was substantial for the identification of any angiographic abnormality (K-alpha = 0.70) and with an angiography assessment scale (K-alpha = 0.60-0.66). There was less agreement for grades of collateral supply (K-alpha = 0.56) or for identification of a perfusion defect on CTA-SI (K-alpha = 0.32). Radiology trainees performed as well as expert readers when additional training was undertaken (neuroradiology specialist trainees). Intra-observer agreement among experts provided similar results (K-alpha = 0.33-0.72). For most imaging characteristics assessed, CTA has moderate to substantial observer agreement in acute ischaemic stroke. Experienced readers and those with specialist training perform best. (orig.)

  16. Observer reliability of CT angiography in the assessment of acute ischaemic stroke: data from the Third International Stroke Trial

    International Nuclear Information System (INIS)

    Mair, Grant; Farrall, Andrew J.; Sellar, Robin J.; Mollison, Daisy; Sakka, Eleni; Palmer, Jeb; Wardlaw, Joanna M.; Kummer, Ruediger von; Adami, Alessandro; White, Philip M.; Adams, Matthew E.; Yan, Bernard; Demchuk, Andrew M.; Ramaswamy, Rajesh; Rodrigues, Mark A.; Samji, Karim; Baird, Andrew J.; Boyd, Elena V.; Cohen, Geoff; Perry, David; Sandercock, Peter A.G.; Lindley, Richard

    2015-01-01

    CT angiography (CTA) is often used for assessing patients with acute ischaemic stroke. Only limited observer reliability data exist. We tested inter- and intra-observer reliability for the assessment of CTA in acute ischaemic stroke. We selected 15 cases from the Third International Stroke Trial (IST-3, ISRCTN25765518) with various degrees of arterial obstruction in different intracranial locations on CTA. To assess inter-observer reliability, seven members of the IST-3 expert image reading panel (>5 years experience reading CTA) and seven radiology trainees (<2 years experience) rated all 15 scans independently and blind to clinical data for: presence (versus absence) of any intracranial arterial abnormality (stenosis or occlusion), severity of arterial abnormality using relevant scales (IST-3 angiography score, Thrombolysis in Cerebral Infarction (TICI) score, Clot Burden Score), collateral supply and visibility of a perfusion defect on CTA source images (CTA-SI). Intra-observer reliability was assessed using independently repeated expert panel scan ratings. We assessed observer agreement with Krippendorff's-alpha (K-alpha). Among experienced observers, inter-observer agreement was substantial for the identification of any angiographic abnormality (K-alpha = 0.70) and with an angiography assessment scale (K-alpha = 0.60-0.66). There was less agreement for grades of collateral supply (K-alpha = 0.56) or for identification of a perfusion defect on CTA-SI (K-alpha = 0.32). Radiology trainees performed as well as expert readers when additional training was undertaken (neuroradiology specialist trainees). Intra-observer agreement among experts provided similar results (K-alpha = 0.33-0.72). For most imaging characteristics assessed, CTA has moderate to substantial observer agreement in acute ischaemic stroke. Experienced readers and those with specialist training perform best. (orig.)

  17. Mapping the rehabilitation interventions of a community stroke team to the extended International Classification of Functioning, Disability and Health Core Set for Stroke.

    Science.gov (United States)

    Evans, Melissa; Hocking, Clare; Kersten, Paula

    2017-12-01

    This study aim was to evaluate whether the Extended International Classification of Functioning, Disability and Health Core Set for Stroke captured the interventions of a community stroke rehabilitation team situated in a large city in New Zealand. It was proposed that the results would identify the contribution of each discipline, and the gaps and differences in service provision to Māori and non-Māori. Applying the Extended International Classification of Functioning, Disability and Health Core Set for Stroke in this way would also inform whether this core set should be adopted in New Zealand. Interventions were retrospectively extracted from 18 medical records and linked to the International Classification of Functioning, Disability and Health and the Extended International Classification of Functioning, Disability and Health Core Set for Stroke. The frequencies of linked interventions and the health discipline providing the intervention were calculated. Analysis revealed that 98.8% of interventions provided by the rehabilitation team could be linked to the Extended International Classification of Functioning, Disability and Health Core Set for Stroke, with more interventions for body function and structure than for activities and participation; no interventions for emotional concerns; and limited interventions for community, social and civic life. Results support previous recommendations for additions to the EICSS. The results support the use of the Extended International Classification of Functioning, Disability and Health Core Set for Stroke in New Zealand and demonstrates its use as a quality assurance tool that can evaluate the scope and practice of a rehabilitation service. Implications for Rehabilitation The Extended International Classification of Functioning Disability and Health Core Set for Stroke appears to represent the stroke interventions of a community stroke rehabilitation team in New Zealand. As a result, researchers and clinicians may have

  18. Virtual rehabilitation via Nintendo Wii® and conventional physical therapy effectively treat post-stroke hemiparetic patients.

    Science.gov (United States)

    da Silva Ribeiro, Nildo Manoel; Ferraz, Daniel Dominguez; Pedreira, Érika; Pinheiro, Ígor; da Silva Pinto, Ana Cláudia; Neto, Mansueto Gomes; Dos Santos, Luan Rafael Aguiar; Pozzato, Michele Gea Guimarães; Pinho, Ricardo Silva; Masruha, Marcelo Rodrigues

    2015-08-01

    The Nintendo® Wii is a simple and affordable virtual therapy alternative. It may be used at home, and it is a motivating recreational activity that provides continuous feedback. However, studies comparing the use of the Nintendo® Wii to conventional physical therapy are needed. To compare the effect of a rehabilitation treatment using the Nintendo® Wii (NW) with conventional physical therapy (CPT) to improve the sensorimotor function and quality of life for post-stroke hemiparetic patients. The present study applied a randomized, blind, and controlled clinical trial. In total, 30 patients with post-stroke hemiparesis were evaluated. A total of 15 patients were randomly assigned to each group. The SF-36 quality of life and Fugl-Meyer scales were used to evaluate the patients. After treatment, the only variable that differed between the groups was the physical functioning domain of the SF-36 in the group that received conventional physical therapy. A significant difference was observed between both groups before and after treatment in terms of the following Fugl-Meyer scale items: passive movement and pain, motor function of the upper limbs (ULs), and balance. The CPT group also showed a significant difference with regard to their UL and lower limb (LL) coordination. The SF-36 scale analysis revealed a significant difference within both groups with regard to the following domains: physical functioning, role limitation due to physical aspects, vitality, and role limitation due to emotional aspects. The NW group also exhibited a significant difference in the mental health domain. The results indicate that both approaches improved the patients' performance in a similar manner. Virtual rehabilitation using the Nintendo Wii® and CPT both effectively treat post-stroke hemiparetic patients by improving passive movement and pain scores, motor function of the upper limb, balance, physical functioning, vitality, and the physical and emotional aspects of role functioning.

  19. Efficacy of a Virtual Reality Commercial Gaming Device in Upper Limb Recovery after Stroke: A Randomized, Controlled Study.

    Science.gov (United States)

    Kong, Keng-He; Loh, Yong-Joo; Thia, Ernest; Chai, Audrey; Ng, Chwee-Yin; Soh, Yan-Ming; Toh, Shirlene; Tjan, Soon-Yin

    2016-10-01

    To compare the efficacy of a virtual reality commercial gaming device, Nintendo wii (NW) with conventional therapy and customary care in facilitating upper limb recovery after stroke. Randomized, controlled, single-blinded study. Tertiary rehabilitation center. 105 subjects admitted to in inpatient rehabilitation program within 6 weeks of stroke onset. Subjects were randomly assigned to one of three groups of upper limb exercises: (1) NW gaming; (2) conventional therapy; (3) control. NW gaming and conventional therapy were provided fourtimes a week for 3 weeks. The main outcome measure was Fugl-Meyer assessment (FMA) of upper limb function. Secondary outcome measures included Action Research Arm Test, Functional Independence Measure, and Stroke Impact Scale. These measures were assessed at baseline, completion of intervention (week 3) and at 4 weeks and 8 weeks after completion of intervention. The primary outcome measure was the change in FMA scores at completion of intervention. The mean age was 57.5±9.8 years, and subjects were enrolled at a mean of 13.7±8.9 days after stroke. The mean baseline FMA score was 16.4±14.2. There was no difference in FMA scores between all 3 groups at the end of intervention, and at 4 and 8 weeks after completion of intervention. Similar findings were also noted for the secondary outcome measures. Twelve sessions of augmented upper limb exercises via NW gaming or conventional therapy over a 3-week period was not effective in enhancing upper limb motor recovery compared to control.

  20. Virtual Teams and International Business Teaching and Learning: The Case of the Global Enterprise Experience (GEE)

    Science.gov (United States)

    Gonzalez-Perez, Maria Alejandra; Velez-Calle, Andres; Cathro, Virginia; Caprar, Dan V.; Taras, Vasyl

    2014-01-01

    The increasing importance of global virtual teams in business is reflected in the classroom by the increased adoption of activities that facilitate real-time cross-cultural interaction. This article documents the experience of students from two Colombian universities who participated in a collaborative international project using virtual teams as…

  1. A diagnostic test for apraxia in stroke patients: internal consistency and diagnostic value.

    NARCIS (Netherlands)

    Heugten, C.M. van; Dekker, J.; Deelman, B.G.; Stehmann-Saris, F.C.; Kinebanian, A.

    1999-01-01

    The internal consistency and the diagnostic value of a test for apraxia in patients having had a stroke are presented. Results indicate that the items of the test form a strong and consistent scale: Cronbach's alpha as well as the results of a Mokken scale analysis present good reliability and good

  2. Assessment of disabilities in stroke patients with apraxia : Internal consistency and inter-observer reliability

    NARCIS (Netherlands)

    van Heugten, CM; Dekker, J; Deelman, BG; Stehmann-Saris, JC; Kinebanian, A

    1999-01-01

    In this paper the internal consistency and inter-observer reliability of the assessment of disabilities in stroke patients with apraxia is presented. Disabilities were assessed by means of observation of activities of daily living (ADL). The study was conducted at occupational therapy departments in

  3. Assessment of disabilities in stroke patients with apraxia: internal consistency and inter-observer reliability.

    NARCIS (Netherlands)

    Heugten, C.M. van; Dekker, J.; Deelman, B.G.; Stehmann-Saris, J.C.; Kinebanian, A.

    1999-01-01

    In this paper the internal consistency and inter-observer reliability of the assessment of disabilities in stroke patients with apraxia is presented. Disabilities were assessed by means of observation of activities of daily living (ADL). The study was conducted at occupational therapy departments in

  4. Side branch absorber for exhaust manifold of two-stroke internal combustion engine

    Science.gov (United States)

    Harris, Ralph E [San Antonio, TX; Broerman, III, Eugene L.; Bourn, Gary D [Laramie, WY

    2011-01-11

    A method of improving scavenging operation of a two-stroke internal combustion engine. The exhaust pressure of the engine is analyzed to determine if there is a pulsation frequency. Acoustic modeling is used to design an absorber. An appropriately designed side branch absorber may be attached to the exhaust manifold.

  5. Language, culture and international exchange of virtual patients.

    Science.gov (United States)

    Muntean, Valentin; Calinici, Tudor; Tigan, Stefan; Fors, Uno G H

    2013-02-11

    Language and cultural differences could be a limiting factor for the international exchange of Virtual Patients (VPs), especially for small countries and languages of limited circulation. Our research evaluated whether it would be feasible to develop a VP based educational program in our Romanian institution, with cases in English and developed in a non-Romanian setting. The participants in the research comprised 4th year Romanian medical students from the Faculty of Medicine in Cluj-Napoca, Romania, with previous training exclusively in Romanian, good English proficiency and no experience with VPs. The students worked on eight VPs in two identical versions, Romanian and English. The first group (2010) of 136 students worked with four VPs developed in Cluj and the second group (2011) of 144 students with four VPs originally developed at an US University. Every student was randomly assigned two different VPs, one in Romanian and another in English. Student activity throughout the case, the diagnosis, therapeutic plan and diagnosis justification were recorded. We also compared student performance on the two VPs versions, Romanian and English and the student performance on the two sets of cases, originally developed in Romania, respectively USA. We found no significant differences between the students' performance on the Romanian vs. English version of VPs. Regarding the students' performance on the two sets of cases, in those originally developed in Romania, respectively in the USA, we found a number of statistically significant differences in the students' activity through the cases. There were no statistically significant differences in the students' ability to reach the correct diagnosis and therapeutic plan. The development of our program with VPs in English would be feasible, cost-effective and in accordance with the globalization of medical education.

  6. Language, culture and international exchange of virtual patients

    Directory of Open Access Journals (Sweden)

    Muntean Valentin

    2013-02-01

    Full Text Available Abstract Background Language and cultural differences could be a limiting factor for the international exchange of Virtual Patients (VPs, especially for small countries and languages of limited circulation. Our research evaluated whether it would be feasible to develop a VP based educational program in our Romanian institution, with cases in English and developed in a non-Romanian setting. Method The participants in the research comprised 4th year Romanian medical students from the Faculty of Medicine in Cluj-Napoca, Romania, with previous training exclusively in Romanian, good English proficiency and no experience with VPs. The students worked on eight VPs in two identical versions, Romanian and English. The first group (2010 of 136 students worked with four VPs developed in Cluj and the second group (2011 of 144 students with four VPs originally developed at an US University. Every student was randomly assigned two different VPs, one in Romanian and another in English. Student activity throughout the case, the diagnosis, therapeutic plan and diagnosis justification were recorded. We also compared student performance on the two VPs versions, Romanian and English and the student performance on the two sets of cases, originally developed in Romania, respectively USA. Results We found no significant differences between the students’ performance on the Romanian vs. English version of VPs. Regarding the students’ performance on the two sets of cases, in those originally developed in Romania, respectively in the USA, we found a number of statistically significant differences in the students’ activity through the cases. There were no statistically significant differences in the students’ ability to reach the correct diagnosis and therapeutic plan. Conclusion The development of our program with VPs in English would be feasible, cost-effective and in accordance with the globalization of medical education.

  7. Virtual Water and Food Security in Tunisia | IDRC - International ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    ... on the world grain market has social implications for Tunisia's small farmers and ... Thus, when a country exports an agricultural product, in effect it also exports ... Tunisia that incorporates the virtual water concept in a food security strategy.

  8. Virtual water trade: an assessment of water use efficiency in the international food trade

    Directory of Open Access Journals (Sweden)

    H. Yang

    2006-01-01

    Full Text Available Amid an increasing water scarcity in many parts of the world, virtual water trade as both a policy instrument and practical means to balance the local, national and global water budget has received much attention in recent years. Building upon the knowledge of virtual water accounting in the literature, this study assesses the efficiency of water use embodied in the international food trade from the perspectives of exporting and importing countries and at the global and country levels. The investigation reveals that the virtual water flows primarily from countries of high crop water productivity to countries of low crop water productivity, generating a global saving in water use. Meanwhile, the total virtual water trade is dominated by green virtual water, which constitutes a low opportunity cost of water use as opposed to blue virtual water. A sensitivity analysis, however, suggests high uncertainties in the virtual water accounting and the estimation of the scale of water saving. The study also raises awareness of the limited effect of water scarcity on the global virtual water trade and the negative implications of the global water saving for the water use efficiency and food security in importing countries and the environment in exporting countries. The analysis shows the complexity in evaluating the efficiency gains in the international virtual water trade. The findings of the study, nevertheless, call for a greater emphasis on rainfed agriculture to improve the global food security and environmental sustainability.

  9. Is upper limb virtual reality training more intensive than conventional training for patients in the subacute phase after stroke?

    DEFF Research Database (Denmark)

    Brunner, Iris; Skouen, Jan Sture; Hofstad, Håkon

    2016-01-01

    Background: Virtual reality (VR) training is thought to improve upper limb (UL) motor function after stroke when utilizing intensive training with many repetitions. The purpose of this study was to compare intensity and content of a VR training intervention to a conventional task......-oriented intervention (CT). Methods: A random sample of 50 video recordings was analyzed of patients with a broad range of UL motor impairments (mean age 61y, 22 women). Patients took part in the VIRTUES trial and were randomized to either VR or CT and stratified according to severity of paresis. A standardized scoring...... and graphical methods were used. Results: Patients in the VR group spent significantly more time actively practicing with an activity rate of 77.6 (8.9) % than patients in the CT 67.3 (13.9) %, (p = .003). This difference was attributed to the subgroup of patients with initially severe paresis (n = 22). While...

  10. Clinical and imaging features associated with intracranial internal carotid artery calcifications in patients with ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Yilmaz, Arda [Mersin University, Department of Neurology, Faculty of Medicine, Mersin (Turkey); Akpinar, Erhan [Hacettepe University, Department of Radiology, Faculty of Medicine, Ankara (Turkey); Topcuoglu, Mehmet Akif; Arsava, Ethem Murat [Hacettepe University, Department of Neurology, Faculty of Medicine, Ankara (Turkey)

    2015-05-01

    Intracranial internal carotid artery calcifications (ICAC), a frequent finding on imaging studies, are predictive of future stroke risk in population-based studies. The clinical significance of this observation among ischemic stroke patients is however less clear. In this study, we analyzed ICAC burden in relation to vascular risk factor profile, stroke etiology, and extent of craniocervical vascular calcifications in a consecutive series of ischemic stroke patients. The burden of ICAC was determined both on non-contrast CT and CT-angiography source images by semiquantitative scoring algorithms. The distribution of vascular risk factors, etiologic stroke subtype, and calcification burden in other craniocervical arteries was assessed among patients with no ICAC, mild-moderate ICAC, and severe ICAC. Of 319 patients included into the study, 28 % had no ICAC, 35 % had mild-moderate ICAC, and 37 % had severe ICAC on CT angiography. Independent factors associated with ICAC burden in multivariate analysis included age (p < 0.001), diabetes mellitus (p = 0.006), and coronary artery disease (p < 0.001). Furthermore, a stroke etiology of large artery atherosclerosis or cardioaortic embolism was significantly related to higher ICAC burden (p = 0.006). Patients with severe ICAC were more likely to harbor calcifications in other vascular beds (p < 0.001). All of these findings persisted when analyses were repeated with CT-based ICAC burden assessments. ICAC burden reflects a continuum of atherosclerotic disease involving carotid arteries together with other craniocervical vascular beds. ICAC is significantly associated with stroke of large vessel or cardioembolic origin. This information might help the clinician in prioritizing etiologic work-up in the acute period. (orig.)

  11. Assessment of visuospatial neglect in stroke patients using virtual reality: a pilot study.

    NARCIS (Netherlands)

    Jannink, M.J.A.; Aznar Alonso, M.A.; de Kort, Alexander Cornelis; van de Vis, Wim; Veltink, Petrus H.; van der Kooij, Herman

    2009-01-01

    One of the neuropsychological deficits that can result from a stroke is the neglect phenomenon. Neglect has traditionally been assessed with paper-and-pencil tasks, which are administered within the reaching space of a person. The purpose of this explorative study is to investigate whether it is

  12. Virtual Reality to control active participation in a subacute stroke patient during robot-assisted gait training.

    Science.gov (United States)

    Bergmann, J; Krewer, C; Müller, F; Koenig, A; Riener, R

    2011-01-01

    Virtual Reality (VR) provides a promising medium to enrich robot assisted rehabilitation. VR applications present the opportunity to engage patients in therapy and control participation. The aim of this study was to investigate two strategies to control active participation of a stroke patient focusing on the involvement of the paretic leg in task solution. A subacute stroke patient with a severe hemiparesis performed two experiments on the driven gait orthosis Lokomat. Patient activity was quantified by weighted interaction torques measured in both legs (experiment A) and the paretic leg only (experiment B). The patient was able to successfully implement both the bilateral and unilateral control modality. Both control modes increased the motor output of the paretic leg, however the paretic leg control mode resulted in a much more differentiated regulation of the activity in the leg. Both control modes are appropriate approaches to enhance active participation and increase motor output in the paretic leg. Further research should evaluate the therapeutic benefit of patients with hemiparesis using the unilateral control mode depending on the severity of their impairment. © 2011 IEEE

  13. Intervention to enhance skilled arm and hand movements after stroke: A feasibility study using a new virtual reality system

    Directory of Open Access Journals (Sweden)

    McLaughlin Margaret

    2007-06-01

    Full Text Available Abstract Background Rehabilitation programs designed to develop skill in upper extremity (UE function after stroke require progressive practice that engage and challenge the learner. Virtual realty (VR provides a unique environment where the presentation of stimuli can be controlled systematically for optimal challenge by adapting task difficulty as performance improves. We describe four VR tasks that were developed and tested to improve arm and hand movement skills for individuals with hemiparesis. Methods Two participants with chronic post-stroke paresis and different levels of motor severity attended 12 training sessions lasting 1 to 2 hours each over a 3-week period. Behavior measures and questionnaires were administered pre-, mid-, and post-training. Results Both participants improved VR task performance across sessions. The less impaired participant averaged more time on task, practiced a greater number of blocks per session, and progressed at a faster rate over sessions than the more impaired participant. Impairment level did not change but both participants improved functional ability after training. The less impaired participant increased the number of blocks moved on the Box & Blocks test while the more impaired participant achieved 4 more items on the Functional Test of the Hemiparetic UE. Conclusion Two participants with differing motor severity were able to engage in VR based practice and improve performance over 12 training sessions. We were able to successfully provide individualized, progressive practice based on each participant's level of movement ability and rate of performance improvement.

  14. Therapists’ Perspective on Virtual Reality Training in Patients after Stroke: A Qualitative Study Reporting Focus Group Results from Three Hospitals

    Directory of Open Access Journals (Sweden)

    Ludwig Schmid

    2016-01-01

    Full Text Available Background. During the past decade, virtual reality (VR has become a new component in the treatment of patients after stroke. Therefore aims of the study were (a to get an insight into experiences and expectations of physiotherapists and occupational therapists in using a VR training system and (b to investigate relevant facilitators, barriers, and risks for implementing VR training in clinical practice. Methods. Three focus groups were conducted with occupational therapists and physiotherapists, specialised in rehabilitation of patients after stroke. All data were audio-recorded and transcribed verbatim. The study was analysed based on a phenomenological approach using qualitative content analysis. Results. After code refinements, a total number of 1289 codes emerged out of 1626 statements. Intercoder reliability increased from 53% to 91% until the last focus group. The final coding scheme included categories on a four-level hierarchy: first-level categories are (a therapists and VR, (b VR device, (c patients and VR, and (d future prospects and potential of VR developments. Conclusions. Results indicate that interprofessional collaboration is needed to develop future VR technology and to devise VR implementation strategies in clinical practice. In principal, VR technology devices were seen as supportive for a general health service model.

  15. Therapists' Perspective on Virtual Reality Training in Patients after Stroke: A Qualitative Study Reporting Focus Group Results from Three Hospitals.

    Science.gov (United States)

    Schmid, Ludwig; Glässel, Andrea; Schuster-Amft, Corina

    2016-01-01

    Background . During the past decade, virtual reality (VR) has become a new component in the treatment of patients after stroke. Therefore aims of the study were (a) to get an insight into experiences and expectations of physiotherapists and occupational therapists in using a VR training system and (b) to investigate relevant facilitators, barriers, and risks for implementing VR training in clinical practice. Methods . Three focus groups were conducted with occupational therapists and physiotherapists, specialised in rehabilitation of patients after stroke. All data were audio-recorded and transcribed verbatim. The study was analysed based on a phenomenological approach using qualitative content analysis. Results . After code refinements, a total number of 1289 codes emerged out of 1626 statements. Intercoder reliability increased from 53% to 91% until the last focus group. The final coding scheme included categories on a four-level hierarchy: first-level categories are (a) therapists and VR, (b) VR device, (c) patients and VR, and (d) future prospects and potential of VR developments. Conclusions . Results indicate that interprofessional collaboration is needed to develop future VR technology and to devise VR implementation strategies in clinical practice. In principal, VR technology devices were seen as supportive for a general health service model.

  16. The combined impact of virtual reality neurorehabilitation and its interfaces on upper extremity functional recovery in patients with chronic stroke.

    Science.gov (United States)

    Cameirão, Mónica S; Badia, Sergi Bermúdez i; Duarte, Esther; Frisoli, Antonio; Verschure, Paul F M J

    2012-10-01

    Although there is strong evidence on the beneficial effects of virtual reality (VR)-based rehabilitation, it is not yet well understood how the different aspects of these systems affect recovery. Consequently, we do not exactly know what features of VR neurorehabilitation systems are decisive in conveying their beneficial effects. To specifically address this issue, we developed 3 different configurations of the same VR-based rehabilitation system, the Rehabilitation Gaming System, using 3 different interface technologies: vision-based tracking, haptics, and a passive exoskeleton. Forty-four patients with chronic stroke were randomly allocated to one of the configurations and used the system for 35 minutes a day for 5 days a week during 4 weeks. Our results revealed significant within-subject improvements at most of the standard clinical evaluation scales for all groups. Specifically we observe that the beneficial effects of VR-based training are modulated by the use/nonuse of compensatory movement strategies and the specific sensorimotor contingencies presented to the user, that is, visual feedback versus combined visual haptic feedback. Our findings suggest that the beneficial effects of VR-based neurorehabilitation systems such as the Rehabilitation Gaming System for the treatment of chronic stroke depend on the specific interface systems used. These results have strong implications for the design of future VR rehabilitation strategies that aim at maximizing functional outcomes and their retention. Clinical Trial Registration- This trial was not registered because it is a small clinical study that evaluates the feasibility of prototype devices.

  17. The use of virtual reality for balance among individuals with chronic stroke: a systematic review and meta-analysis.

    Science.gov (United States)

    Iruthayarajah, Jerome; McIntyre, Amanda; Cotoi, Andreea; Macaluso, Steven; Teasell, Robert

    2017-01-01

    Virtual reality (VR) is becoming a popular alternative to traditional upper and lower limb rehabilitation following a stroke. To conduct a systematic review and meta-analysis on the effectiveness of VR interventions for improving balance in a chronic stroke (≥6 months) population. A literature search of Pubmed, Scopus, CINAHL, Embase, Psycinfo, and Web of Science databases was conducted. English randomized controlled trials published up to September 2015 assessing balance with VR in chronic stroke participants. Mean and standard deviations from outcome measures were extracted. Pooled standard mean differences ± standard error were calculated for the Berg Balance Scale (BBS) and the Timed Up and Go test (TUG). In total, 20 studies were selected which assessed the Nintendo ® Wii Fit balance board (n = 7), treadmill training and VR (n = 7), and postural training using VR (n = 6). Significant improvements were found for VR interventions evaluating the BBS (n = 12; MD = 2.94 ± 0.57; p effect on BBS (n = 5) and TUG (n = 3) scores (BBS: MD = 3.82 ± 0.79; p effect on TUG scores (MD = 2.15 ± 0.89, p = 0.016). Overall, VR interventions compared to conventional rehabilitation had significant improvements. The meta-analyses also suggest that the Nintendo ® Wii Fit balance board may not be effective, although further confirmatory studies are necessary. Results should be interpreted with caution due to differences in therapy intensities and effect sizes within the included studies.

  18. The Effect of a Virtual Reality Game Intervention on Balance for Patients with Stroke: A Randomized Controlled Trial.

    Science.gov (United States)

    Lee, Hsin-Chieh; Huang, Chia-Lin; Ho, Sui-Hua; Sung, Wen-Hsu

    2017-10-01

    The aim of this study was to investigate the effects of virtual reality (VR) balance training conducted using Kinect for Xbox® games on patients with chronic stroke. Fifty patients with mild to moderate motor deficits were recruited and randomly assigned to two groups: VR plus standard treatment group and standard treatment (ST) group. In total, 12 training sessions (90 minutes a session, twice a week) were conducted in both groups, and performance was assessed at three time points (pretest, post-test, and follow-up) by a blinded assessor. The outcome measures were the Berg Balance Scale (BBS), Functional Reach Test, and Timed Up and Go Test (cognitive; TUG-cog) for balance evaluations; Modified Barthel Index for activities of daily living ability; Activities-specific Balance Confidence Scale for balance confidence; and Stroke Impact Scale for quality of life. The pleasure scale and adverse events were also recorded after each training session. Both groups exhibited significant improvement over time in the BBS (P = 0.000) and TUG-cog test (P = 0.005). The VR group rated the experience as more pleasurable than the ST group during the intervention (P = 0.027). However, no significant difference was observed in other outcome measures within or between the groups. No serious adverse events were observed during the treatment in either group. VR balance training by using Kinect for Xbox games plus the traditional method had positive effects on the balance ability of patients with chronic stroke. The VR group experienced higher pleasure than the ST group during the intervention.

  19. Autonomous rehabilitation at stroke patients home for balance and gait: safety, usability and compliance of a virtual reality system.

    Science.gov (United States)

    Held, Jeremia P; Ferrer, Begoña; Mainetti, Renato; Steblin, Alexander; Hertler, Benjamin; Moreno-Conde, Alberto; Dueñas, Alvaro; Pajaro, Marta; L-Parra-Calderón, Carlos; Vargiu, Eloisa; Zarco, Maria J; Barrera, Maria; Echevarria, Carmen; Jódar-Sánchez, Francisco; Luft, Andreas R; Borghese, Nunzio A

    2017-09-25

    New technologies, such as telerehabilitation and gaming devices offer the possibility for patients to train at home. This opens the challenge of safety for the patient as he is called to exercise neither with a therapist on the patients' side nor with a therapist linked remotely to supervise the sessions. To study the safety, usability and patient acceptance of an autonomous telerehabilitation system for balance and gait (the REWIRE platform) in the patients home. Cohort study. Community, in the stroke patients' home. 15 participants with first-ever stroke, with a mild to moderate residual deficit of the lower extremities. Autonomous rehabilitation based on virtual rehabilitation was provided at the participants' home for twelve weeks. The primary outcome was compliance (the ratio between days of actual and scheduled training), analysed with the two-tailed Wilcoxon Mann- Whitney test. Furthermore safety is defined by adverse events. The secondary endpoint was the acceptance of the system measured with the Technology Acceptance Model. Additionally, the cumulative duration of weekly training was analysed. During the study there were no adverse events related to the therapy. Patients performed on average 71% (range 39 to 92%) of the scheduled sessions. The Technology Acceptance Model Questionnaire showed excellent values for stroke patients after the training. The average training duration per week was 99 ±53min. Autonomous telerehabilitation for balance and gait training with the REWIRE-system is safe, feasible and can help to intensive rehabilitative therapy at home. Telerehabilitation enables safe training in home environment and supports of the standard rehabilitation therapy.

  20. Effectiveness of commercial gaming-based virtual reality movement therapy on functional recovery of upper extremity in subacute stroke patients.

    Science.gov (United States)

    Choi, Jun Hwan; Han, Eun Young; Kim, Bo Ryun; Kim, Sun Mi; Im, Sang Hee; Lee, So Young; Hyun, Chul Woong

    2014-08-01

    To investigate the effectiveness of commercial gaming-based virtual reality (VR) therapy on the recovery of paretic upper extremity in subacute stroke patients. Twenty patients with the first-onset subacute stroke were enrolled and randomly assigned to the case group (n=10) and the control group (n=10). Primary outcome was measured by the upper limb score through the Fugl-Meyer Assessment (FMA-UL) for the motor function of both upper extremities. Secondary outcomes were assessed for motor function of both upper extremities including manual function test (MFT), box and block test (BBT), grip strength, evaluated for activities of daily living (Korean version of Modified Barthel Index [K-MBI]), and cognitive functions (Korean version of the Mini-Mental State Examination [K-MMSE] and continuous performance test [CPT]). The case group received commercial gaming-based VR therapy using Wii (Nintendo, Tokyo, Japan), and the control group received conventional occupational therapy (OT) for 30 minutes a day during the period of 4 weeks. All patients were evaluated before and after the 4-week intervention. There were no significant differences in the baseline between the two groups. After 4 weeks, both groups showed significant improvement in the FMA-UL, MFT, BBT, K-MBI, K-MMSE, and correct detection of auditory CPT. However, grip strength was improved significantly only in the case group. There were no significant intergroup differences before and after the treatment. These findings suggested that the commercial gaming-based VR therapy was as effective as conventional OT on the recovery of upper extremity motor and daily living function in subacute stroke patients.

  1. Effects of virtual reality-based training with BTs-Nirvana on functional recovery in stroke patients: preliminary considerations.

    Science.gov (United States)

    De Luca, Rosaria; Russo, Margherita; Naro, Antonino; Tomasello, Provvidenza; Leonardi, Simona; Santamaria, Floriana; Desireè, Latella; Bramanti, Alessia; Silvestri, Giuseppe; Bramanti, Placido; Calabrò, Rocco Salvatore

    2018-02-02

    Cognitive impairment occurs frequently in post-stroke patients. This study aimed to determine the effects of a virtual reality training (VRT) with BTs-Nirvana (BTsN) on the recovery of cognitive functions in stroke patients, using the Interactive-Semi-Immersive Program (I-SIP). We enrolled 12 subjects (randomly divided into two groups: experimental group (EG); and control group (CG)), who attended the Laboratory of Robotic and Cognitive Rehabilitation of IRCCS Neurolesi of Messina from January to June 2016. The EG underwent a VRT with BTsN, whereas CG received a standard cognitive treatment. Both the groups underwent the same conventional physiotherapy program. Each treatment session lasted 45 minutes and was repeated three times a week for 8 weeks. All the patients were evaluated by a specific clinical-psychometric battery before (T0), immediately (T1), and one month (T2) after the end of the training. At T1, the EG presented a greater improvement in the trunk control test (p = 0.03), the Montreal Cognitive Assessment (p = 0.01), the selective attention assessment scores (p = 0.01), the verbal memory (p = 0.03), and the visuospatial and constructive abilities (p = 0.01), as compared to CG. Moreover, such amelioration persisted at T2 only in the EG. According to these preliminary data, VRT with I-SIP can be considered a useful complementary treatment to potentiate functional recovery, with regard to attention, visual-spatial deficits, and motor function in patients affected by stroke.

  2. Effectiveness of Virtual Reality Exercises in STroke Rehabilitation (EVREST): rationale, design, and protocol of a pilot randomized clinical trial assessing the Wii gaming system.

    Science.gov (United States)

    Saposnik, G; Mamdani, M; Bayley, M; Thorpe, K E; Hall, J; Cohen, L G; Teasell, R

    2010-02-01

    Evidence suggests that increasing intensity of rehabilitation results in better motor recovery. Limited evidence is available on the effectiveness of an interactive virtual reality gaming system for stroke rehabilitation. EVREST was designed to evaluate feasibility, safety and efficacy of using the Nintendo Wii gaming virtual reality (VRWii) technology to improve arm recovery in stroke patients. Pilot randomized study comparing, VRWii versus recreational therapy (RT) in patients receiving standard rehabilitation within six months of stroke with a motor deficit of > or =3 on the Chedoke-McMaster Scale (arm). In this study we expect to randomize 20 patients. All participants (age 18-85) will receive customary rehabilitative treatment consistent of a standardized protocol (eight sessions, 60 min each, over a two-week period). The primary feasibility outcome is the total time receiving the intervention. The primary safety outcome is the proportion of patients experiencing intervention-related adverse events during the study period. Efficacy, a secondary outcome measure, will be measured by the Wolf Motor Function Test, Box and Block Test, and Stroke Impact Scale at the four-week follow-up visit. From November, 2008 to September, 2009 21 patients were randomized to VRWii or RT. Mean age, 61 (range 41-83) years. Mean time from stroke onset 25 (range 10-56) days. EVREST is the first randomized parallel controlled trial assessing the feasibility, safety, and efficacy of virtual reality using Wii gaming technology in stroke rehabilitation. The results of this study will serve as the basis for a larger multicentre trial. ClinicalTrials.gov registration# NTC692523.

  3. Constant speed control of four-stroke micro internal combustion swing engine

    Science.gov (United States)

    Gao, Dedong; Lei, Yong; Zhu, Honghai; Ni, Jun

    2015-09-01

    The increasing demands on safety, emission and fuel consumption require more accurate control models of micro internal combustion swing engine (MICSE). The objective of this paper is to investigate the constant speed control models of four-stroke MICSE. The operation principle of the four-stroke MICSE is presented based on the description of MICSE prototype. A two-level Petri net based hybrid model is proposed to model the four-stroke MICSE engine cycle. The Petri net subsystem at the upper level controls and synchronizes the four Petri net subsystems at the lower level. The continuous sub-models, including breathing dynamics of intake manifold, thermodynamics of the chamber and dynamics of the torque generation, are investigated and integrated with the discrete model in MATLAB Simulink. Through the comparison of experimental data and simulated DC voltage output, it is demonstrated that the hybrid model is valid for the four-stroke MICSE system. A nonlinear model is obtained from the cycle average data via the regression method, and it is linearized around a given nominal equilibrium point for the controller design. The feedback controller of the spark timing and valve duration timing is designed with a sequential loop closing design approach. The simulation of the sequential loop closure control design applied to the hybrid model is implemented in MATLAB. The simulation results show that the system is able to reach its desired operating point within 0.2 s, and the designed controller shows good MICSE engine performance with a constant speed. This paper presents the constant speed control models of four-stroke MICSE and carries out the simulation tests, the models and the simulation results can be used for further study on the precision control of four-stroke MICSE.

  4. Dynamic and Thermodynamic Examination of a Two-Stroke Internal Combustion Engine

    OpenAIRE

    İPCİ, Duygu; KARABULUT, Halit

    2016-01-01

    In this study the combined dynamic and thermodynamic analysis of a two-stroke internal combustion engine was carried out. The variation of the heat, given to the working fluid during the heating process of the thermodynamic cycle, was modeled with the Gaussian function. The dynamic model of the piston driving mechanism was established by means of nine equations, five of them are motion equations and four of them are kinematic relations. Equations are solved by using a numerical method based o...

  5. A comparative analysis of 2D and 3D tasks for virtual reality therapies based on robotic-assisted neurorehabilitation for post-stroke patients

    Directory of Open Access Journals (Sweden)

    Luis Daniel Lledó

    2016-08-01

    Full Text Available Post-stroke neurorehabilitation based on virtual therapies are performed completing repetitive exercises shown in visual electronic devices, whose content represents imaginary or daily life tasks. Currently, there are two ways of visualization of these task. 3D virtual environments are used to get a three dimensional space that represents the real world with a high level of detail, whose realism is determinated by the resolucion and fidelity of the objects of the task. Furthermore, 2D virtual environments are used to represent the tasks with a low degree of realism using techniques of bidimensional graphics. However, the type of visualization can influence the quality of perception of the task, affecting the patient's sensorimotor performance. The purpose of this paper was to evaluate if there were differences in patterns of kinematic movements when post-stroke patients performed a reach task viewing a virtual therapeutic game with two different type of visualization of virtual environment: 2D and 3D. Nine post-stroke patients have participated in the study receiving a virtual therapy assisted by PUPArm rehabilitation robot. Horizontal movements of the upper limb were performed to complete the aim of the tasks, which consist in reaching peripheral or perspective targets depending on the virtual environment shown. Various parameter types such as the maximum speed, reaction time, path length or initial movement are analyzed from the data acquired objectively by the robotic device to evaluate the influence of the task visualization. At the end of the study, a usability survey was provided to each patient to analysis his/her satisfaction level. For all patients, the movement trajectories were enhanced when they completed the therapy. This fact suggests that patient's motor recovery was increased. Despite of the similarity in majority of the kinematic parameters, differences in reaction time and path length were higher using the 3D task. Regarding

  6. Self-directed arm therapy at home after stroke with a sensor-based virtual reality training system.

    Science.gov (United States)

    Wittmann, Frieder; Held, Jeremia P; Lambercy, Olivier; Starkey, Michelle L; Curt, Armin; Höver, Raphael; Gassert, Roger; Luft, Andreas R; Gonzenbach, Roman R

    2016-08-11

    The effect of rehabilitative training after stroke is dose-dependent. Out-patient rehabilitation training is often limited by transport logistics, financial resources and a lack of motivation/compliance. We studied the feasibility of an unsupervised arm therapy for self-directed rehabilitation therapy in patients' homes. An open-label, single group study involving eleven patients with hemiparesis due to stroke (27 ± 31.5 months post-stroke) was conducted. The patients trained with an inertial measurement unit (IMU)-based virtual reality system (ArmeoSenso) in their homes for six weeks. The self-selected dose of training with ArmeoSenso was the principal outcome measure whereas the Fugl-Meyer Assessment of the upper extremity (FMA-UE), the Wolf Motor Function Test (WMFT) and IMU-derived kinematic metrics were used to assess arm function, training intensity and trunk movement. Repeated measures one-way ANOVAs were used to assess differences in training duration and clinical scores over time. All subjects were able to use the system independently in their homes and no safety issues were reported. Patients trained on 26.5 ± 11.5 days out of 42 days for a duration of 137 ± 120 min per week. The weekly training duration did not change over the course of six weeks (p = 0.146). The arm function of these patients improved significantly by 4.1 points (p = 0.003) in the FMA-UE. Changes in the WMFT were not significant (p = 0.552). ArmeoSenso based metrics showed an improvement in arm function, a high number of reaching movements (387 per session), and minimal compensatory movements of the trunk while training. Self-directed home therapy with an IMU-based home therapy system is safe and can provide a high dose of rehabilitative therapy. The assessments integrated into the system allow daily therapy monitoring, difficulty adaptation and detection of maladaptive motor patterns such as trunk movements during reaching. Unique identifier: NCT02098135 .

  7. Improving post-stroke cognitive and behavioral abnormalities by using virtual reality: A case report on a novel use of nirvana.

    Science.gov (United States)

    De Luca, Rosaria; Torrisi, Michele; Piccolo, Adriana; Bonfiglio, Giovanni; Tomasello, Provvidenza; Naro, Antonino; Calabrò, Rocco Salvatore

    2017-10-11

    Cognitive impairment, as well as mood and anxiety disorders, occur frequently in patients following stroke. Aim of this study was to evaluate the effects of a combined rehabilitative treatment using conventional relaxation and respiratory techniques, in a specific rehabilitative virtual environment (by using Bts-Nirvana). A 58-year-old woman, affected by hemorrhagic stroke, underwent two different rehabilitation trainings, including either standard relaxation techniques alone in a common clinical setting or the same psychological approach in a semi-immersive virtual environment with an augmented sensorial (audio-video) and motor feedback (sensory motor-interaction). We evaluated the patient's cognitive and psychological profile before and after the two different trainings, by using a specific psychometric battery, aimed to assess cognitive status, attention processes and to estimate the presence of mood alterations, anxiety and coping strategies. Only at the end of the combined approach, we observed a significant improvement in attention and memory functions, with a nearly complete relief of anxiety symptoms and an improvement in coping strategies. Relaxation and respiratory techniques in a semi-immersive virtual reality environment, using Bts-Nirvana, may be a promising tool in improving attention process, coping strategies, and anxiety in individuals with neurological disorders, including stroke.

  8. NASA's Solar System Exploration Research Virtual Institute: Building Collaboration Through International Partnerships

    Science.gov (United States)

    Gibbs, K. E.; Schmidt, G. K.

    2017-01-01

    The NASA Solar System Exploration Research Virtual Institute (SSERVI) is a virtual institute focused on re-search at the intersection of science and exploration, training the next generation of lunar scientists, and community development. As part of the SSERVI mission, we act as a hub for opportunities that engage the larger scientific and exploration communities in order to form new interdisciplinary, research-focused collaborations. This talk will describe the international partner re-search efforts and how we are engaging the international science and exploration communities through workshops, conferences, online seminars and classes, student exchange programs and internships.

  9. Patients' and Health Professionals' Experiences of Using Virtual Reality Technology for Upper Limb Training after Stroke: A Qualitative Substudy.

    Science.gov (United States)

    Pallesen, Hanne; Andersen, Mette Brændstrup; Hansen, Gunhild Mo; Lundquist, Camilla Biering; Brunner, Iris

    2018-01-01

    In recent years, virtual reality (VR) therapy systems for upper limb training after stroke have been increasingly used in clinical practice. Therapy systems employing VR technology can enhance the intensity of training and can also boost patients' motivation by adding a playful element to therapy. However, reports on user experiences are still scarce. A qualitative investigation of patients' and therapists' perspectives on VR upper limb training. Semistructured face-to-face interviews were conducted with six patients in the final week of the VR intervention. Therapists participated in two focus group interviews after the completion of the intervention. The interviews were analyzed from a phenomenological perspective emphasizing the participants' perceptions and interpretations. Five key themes were identified from the patients' perspectives: (i) motivational factors, (ii) engagement, (iii) perceived improvements, (iv) individualization, and (v) device malfunction. The health professionals described the same themes as the patients but less positively, emphasizing negative technical challenges. Patients and therapists mainly valued the intensive and motivational character of VR training. The playful nature of the training appeared to have a significant influence on the patients' moods and engagement and seemed to promote a "gung-ho" spirit, so they felt that they could perform more repetitions.

  10. Patients’ and Health Professionals’ Experiences of Using Virtual Reality Technology for Upper Limb Training after Stroke: A Qualitative Substudy

    Directory of Open Access Journals (Sweden)

    Hanne Pallesen

    2018-01-01

    Full Text Available Background. In recent years, virtual reality (VR therapy systems for upper limb training after stroke have been increasingly used in clinical practice. Therapy systems employing VR technology can enhance the intensity of training and can also boost patients’ motivation by adding a playful element to therapy. However, reports on user experiences are still scarce. Methods. A qualitative investigation of patients’ and therapists’ perspectives on VR upper limb training. Semistructured face-to-face interviews were conducted with six patients in the final week of the VR intervention. Therapists participated in two focus group interviews after the completion of the intervention. The interviews were analyzed from a phenomenological perspective emphasizing the participants’ perceptions and interpretations. Results. Five key themes were identified from the patients’ perspectives: (i motivational factors, (ii engagement, (iii perceived improvements, (iv individualization, and (v device malfunction. The health professionals described the same themes as the patients but less positively, emphasizing negative technical challenges. Conclusion. Patients and therapists mainly valued the intensive and motivational character of VR training. The playful nature of the training appeared to have a significant influence on the patients’ moods and engagement and seemed to promote a “gung-ho” spirit, so they felt that they could perform more repetitions.

  11. Development of a system based on 3D vision, interactive virtual environments, ergonometric signals and a humanoid for stroke rehabilitation.

    Science.gov (United States)

    Ibarra Zannatha, Juan Manuel; Tamayo, Alejandro Justo Malo; Sánchez, Angel David Gómez; Delgado, Jorge Enrique Lavín; Cheu, Luis Eduardo Rodríguez; Arévalo, Wilson Alexander Sierra

    2013-11-01

    This paper presents a stroke rehabilitation (SR) system for the upper limbs, developed as an interactive virtual environment (IVE) based on a commercial 3D vision system (a Microsoft Kinect), a humanoid robot (an Aldebaran's Nao), and devices producing ergonometric signals. In one environment, the rehabilitation routines, developed by specialists, are presented to the patient simultaneously by the humanoid and an avatar inside the IVE. The patient follows the rehabilitation task, while his avatar copies his gestures that are captured by the Kinect 3D vision system. The information of the patient movements, together with the signals obtained from the ergonometric measurement devices, is used also to supervise and to evaluate the rehabilitation progress. The IVE can also present an RGB image of the patient. In another environment, that uses the same base elements, four game routines--Touch the balls 1 and 2, Simon says, and Follow the point--are used for rehabilitation. These environments are designed to create a positive influence in the rehabilitation process, reduce costs, and engage the patient. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  12. Virtual water flows in the international trade of agricultural products of China.

    Science.gov (United States)

    Zhang, Yu; Zhang, Jinhe; Tang, Guorong; Chen, Min; Wang, Lachun

    2016-07-01

    With the rapid development of the economy and population, water scarcity and poor water quality caused by water pollution have become increasingly severe in China. Virtual water trade is a useful tool to alleviate water shortage. This paper focuses on a comprehensive study of China's international virtual water flows from agricultural products trade and completes a diachronic analysis from 2001 to 2013. The results show that China was in trade surplus in relation to the virtual water trade of agricultural products. The exported virtual water amounted to 29.94billionm(3)/yr. while 155.55billionm(3)/yr. was embedded in imported products. The trend that China exported virtual water per year was on the decline while the imported was on a rising trend. Virtual water trade of China was highly concentrated. Not all of the exported products had comparative advantages in virtual water content. Imported products were excessively concentrated on water intensive agricultural products such as soya beans, cotton, and palm oil. The exported virtual water mainly flowed to the Republic of Korea, Hong Kong of China and Japan, while the imported mainly flowed from the United States of America, Brazil and Argentina. From the ethical point of view, the trade partners were classified into four types in terms of "net import" and "water abundance": mutual benefit countries, such as Australia and Canada; unilateral benefit countries, such as Mongolia and Norway; supported countries, such as Egypt and Singapore; and double pressure countries, such as India and Pakistan. Virtual water strategy refers to water resources, agricultural products and human beings. The findings are beneficial for innovating water resources management system, adjusting trade structure, ensuring food security in China, and promoting the construction of national ecological security system. Copyright © 2016 Elsevier B.V. All rights reserved.

  13. Virtual Field and Internal Structure of Half-Dressed Extended Particles

    International Nuclear Information System (INIS)

    Compagno, G.; Persico, F.

    1988-01-01

    A new method is proposed to investigate the internal geometrical structure of an extended particle surrounded by an incomplete virtual dressing field. This method involves analysing the time-dependent virtual field at large distances from the particle, without any direct interaction with the latter. As an example, the pulselike, time-dependent virtual field of an extended QED source is investigated using a model which has a well-known counterpart in meson theory. In the framework of nonrelativistic QED it is shown that, contrary to the case of a point source, the pulse has finite width and height. For the case of a spherically symmetric source, it is explicitly shown that the width and shape of the pulse at distance r from the particle depend on the parameters determining the space structure of the source. It is concluded that the study of the field of half-dressed particles may provide a new method to investigate their internal structure

  14. A task-specific interactive game-based virtual reality rehabilitation system for patients with stroke: a usability test and two clinical experiments.

    Science.gov (United States)

    Shin, Joon-Ho; Ryu, Hokyoung; Jang, Seong Ho

    2014-03-06

    Virtual reality (VR) is not commonly used in clinical rehabilitation, and commercial VR gaming systems may have mixed effects in patients with stroke. Therefore, we developed RehabMaster™, a task-specific interactive game-based VR system for post-stroke rehabilitation of the upper extremities, and assessed its usability and clinical efficacy. A participatory design and usability tests were carried out for development of RehabMaster with representative user groups. Two clinical trials were then performed. The first was an observational study in which seven patients with chronic stroke received 30 minutes of RehabMaster intervention per day for two weeks. The second was a randomised controlled trial of 16 patients with acute or subacute stroke who received 10 sessions of conventional occupational therapy only (OT-only group) or conventional occupational therapy plus 20 minutes of RehabMaster intervention (RehabMaster + OT group). The Fugl-Meyer Assessment score (FMA), modified Barthel Index (MBI), adverse effects, and drop-out rate were recorded. The requirements of a VR system for stroke rehabilitation were established and incorporated into RehabMaster. The reported advantages from the usability tests were improved attention, the immersive flow experience, and individualised intervention. The first clinical trial showed that the RehabMaster intervention improved the FMA (P = .03) and MBI (P = .04) across evaluation times. The second trial revealed that the addition of RehabMaster intervention tended to enhance the improvement in the FMA (P = .07) but did not affect the improvement in the MBI. One patient with chronic stroke left the trial, and no adverse effects were reported. The RehabMaster is a feasible and safe VR system for enhancing upper extremity function in patients with stroke.

  15. Asymmetric training using virtual reality reflection equipment and the enhancement of upper limb function in stroke patients: a randomized controlled trial.

    Science.gov (United States)

    Lee, DongJin; Lee, MyungMo; Lee, KyoungJin; Song, ChangHo

    2014-07-01

    Asymmetric movements with both hands contributed to the improvement of spatially coupled motion. Thus, the aim of this study was to investigate the effects of an asymmetric training program using virtual reality reflection equipment on upper limb function in stroke patients. Twenty-four stroke patients were randomly allocated to an experimental group (n=12) or a control group (n=12). Both groups participated in conventional physical therapy for 2×30 min/d, 5 d/wk, for 4 weeks. The experimental group also participated in an asymmetric training program using virtual reality reflection equipment, and the control group participated in a symmetric training program. Both asymmetric and symmetric programs were conducted for 30 min/d, 5 d/wk, for 4 weeks. To compare upper limb function before and after intervention, the Fugl-Meyer Assessment (FMA), the Box and Block Test (BBT), grip strength, range of motion (ROM), and spasticity were assessed. Both groups showed significant increases in upper limb function, excepting spasticity, after intervention (Pinteraction was demonstrated only for shoulder/elbow/wrist items of FMA, BBT, grip strength, and ROM of wrist flexion, extension, and ulnar deviation (Pvirtual reality reflection equipment is an effective intervention method for improving upper limb function in stroke patients. We consider that an additional study based on a program using virtual reflection, which is more functional than performing simple tasks, and consisting of tasks relevant to the activities of daily living be conducted. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  16. Online International Learning: Internationalising the Curriculum through Virtual Mobility at Coventry University

    Science.gov (United States)

    Villar-Onrubia, Daniel; Rajpal, Brinder

    2016-01-01

    Virtual mobility initiatives are one of the most flexible, versatile and inclusive approaches in the provision of international experience opportunities. Given that in most universities only a small fraction of students can benefit from forms of academic mobility that involve travelling abroad, Internet-based intercultural interactions prove to be…

  17. Virtual Reality Rehabilitation With Functional Electrical Stimulation Improves Upper Extremity Function in Patients With Chronic Stroke: A Pilot Randomized Controlled Study.

    Science.gov (United States)

    Lee, Stephanie Hyeyoung; Lee, Ji-Yeong; Kim, Mi-Young; Jeon, Yu-Jin; Kim, Suyoung; Shin, Joon-Ho

    2018-03-02

    To compare virtual reality (VR) combined with functional electrical stimulation (FES) with cyclic FES for improving upper extremity function and health-related quality of life in patients with chronic stroke. A pilot, randomized, single-blind, controlled trial. Stroke rehabilitation inpatient unit. Participants (N=48) with hemiplegia secondary to a unilateral stroke for >3 months and with a hemiplegic wrist extensor Medical Research Council scale score ranging from 1 to 3. FES was applied to the wrist extensors and finger extensors. A VR-based wearable rehabilitation device was used combined with FES and virtual activity-based training for the intervention group. The control group received cyclic FES only. Both groups completed 20 sessions over a 4-week period. Primary outcome measures were changes in Fugl-Meyer Assessment-Upper Extremity and Wolf Motor Function Test scores. Secondary outcome measures were changes in Box and Block Test, Jebsen-Taylor Hand Function Test, and Stroke Impact Scale scores. Assessments were performed at baseline (t0) and at 2 weeks (t1), 4 weeks (t4), and 8 weeks (t8). Between-group comparisons were evaluated using a repeated-measures analysis of variance. Forty-one participants were included in the analysis. Compared with FES alone, VR-FES produced a substantial increase in Fugl-Meyer Assessment-distal score (P=.011) and marginal improvement in Jebsen-Taylor Hand Function Test-gross score (P=.057). VR-FES produced greater, although nonsignificant, improvements in all other outcome measures, except in the Stroke Impact Scale-activities of daily living/instrumental activities of daily living score. FES with VR-based rehabilitation may be more effective than cyclic FES in improving distal upper extremity gross motor performance poststroke. Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  18. Closed-Loop Task Difficulty Adaptation during Virtual Reality Reach-to-Grasp Training Assisted with an Exoskeleton for Stroke Rehabilitation.

    Science.gov (United States)

    Grimm, Florian; Naros, Georgios; Gharabaghi, Alireza

    2016-01-01

    Stroke patients with severe motor deficits of the upper extremity may practice rehabilitation exercises with the assistance of a multi-joint exoskeleton. Although this technology enables intensive task-oriented training, it may also lead to slacking when the assistance is too supportive. Preserving the engagement of the patients while providing "assistance-as-needed" during the exercises, therefore remains an ongoing challenge. We applied a commercially available seven degree-of-freedom arm exoskeleton to provide passive gravity compensation during task-oriented training in a virtual environment. During this 4-week pilot study, five severely affected chronic stroke patients performed reach-to-grasp exercises resembling activities of daily living. The subjects received virtual reality feedback from their three-dimensional movements. The level of difficulty for the exercise was adjusted by a performance-dependent real-time adaptation algorithm. The goal of this algorithm was the automated improvement of the range of motion. In the course of 20 training and feedback sessions, this unsupervised adaptive training concept led to a progressive increase of the virtual training space ( p learning curve was paralleled by a concurrent improvement of real world kinematic parameters, i.e., range of motion ( p = 0.008), accuracy of movement ( p = 0.01), and movement velocity ( p virtual reality provides customized rehabilitation environments for severely affected stroke patients. This approach may facilitate motor learning by progressively challenging the subject in accordance with the individual capacity for functional restoration. It might be necessary to apply concurrent restorative interventions to translate these improvements into relevant functional gains of severely motor impaired patients in activities of daily living.

  19. Virtual reality based rehabilitation speeds up functional recovery of the upper extremities after stroke: a randomized controlled pilot study in the acute phase of stroke using the rehabilitation gaming system.

    Science.gov (United States)

    da Silva Cameirão, Mónica; Bermúdez I Badia, Sergi; Duarte, Esther; Verschure, Paul F M J

    2011-01-01

    Given the incidence of stroke, the need has arisen to consider more self-managed rehabilitation approaches. A promising technology is Virtual Reality (VR). Thus far, however, it is not clear what the benefits of VR systems are when compared to conventional methods. Here we investigated the clinical impact of one such system, the Rehabilitation Gaming System (RGS), on the recovery time course of acute stroke. RGS combines concepts of action execution and observation with an automatic individualization of training. METHODS. Acute stroke patients (n = 8) used the RGS during 12 weeks in addition to conventional therapy. A control group (n = 8) performed a time matched alternative treatment, which consisted of intense occupational therapy or non-specific interactive games. RESULTS. At the end of the treatment, between-group comparisons showed that the RGS group displayed significantly improved performance in paretic arm speed that was matched by better performance in the arm subpart of the Fugl-Meyer Assessment Test and the Chedoke Arm and Hand Activity Inventory. In addition, the RGS group presented a significantly faster improvement over time for all the clinical scales during the treatment period. CONCLUSIONS. Our results suggest that rehabilitation with the RGS facilitates the functional recovery of the upper extremities and that this system is therefore a promising tool for stroke neurorehabilitation.

  20. The feasibility, acceptability and preliminary efficacy of a low-cost, virtual-reality based, upper-limb stroke rehabilitation device: a mixed methods study.

    Science.gov (United States)

    Warland, Alyson; Paraskevopoulos, Ioannis; Tsekleves, Emmanuel; Ryan, Jennifer; Nowicky, Alexander; Griscti, Josephine; Levings, Hannah; Kilbride, Cherry

    2018-04-12

    To establish feasibility, acceptability, and preliminary efficacy of an adapted version of a commercially available, virtual-reality gaming system (the Personalised Stroke Therapy system) for upper-limb rehabilitation with community dwelling stroke-survivors. Twelve stroke-survivors (nine females, mean age 58 years, [standard deviation 7.1], median stroke chronicity 42 months [interquartile range 34.7], Motricity index 14-25 for shoulder and elbow) were asked to complete nine, 40-min intervention sessions using two activities on the system over 3 weeks. Feasibility and acceptability were assessed through a semi-structured interview, recording of adverse effects, adherence, enjoyment (using an 11-point Likert scale), and perceived exertion (using the BORG scale). Assessments of impairment (Fugl-Meyer Assessment Upper extremity), activity (ABILHAND, Action Research Arm Test, Motor Activity Log-28), and participation (Subjective Index of Physical and Social Outcome) were completed at baseline, following intervention, and at 4-week follow-up. Data were analysed using Thematic Analysis of interview and intervention field-notes and Wilcoxon Signed Ranks. Side-by-side displays were used to integrate findings. Participants received between 175 and 336 min of intervention. Thirteen non-serious adverse effects were reported by five participants. Participants reported a high level of enjoyment (8.1 and 6.8 out of 10) and rated exertion between 11.6 and 12.9 out of 20. Themes of improvements in impairments and increased spontaneous use in functional activities were identified and supported by improvements in all outcome measures between baseline and post-intervention (p technologies for use in upper-limb stroke rehabilitation should be personalised, dependent on individual need. Through the use of hands-free systems and personalisation, stroke survivors with moderate and moderately-severe levels of upper-limb impairment following stroke are able to use gaming technologies

  1. The emergence of internet-based virtual private networks in international safeguards

    International Nuclear Information System (INIS)

    Smartt, Heidi Anne

    2001-01-01

    Full text: The costs associated with secure data transmission can be an obstacle to International Safeguards. Typical communication methods are priced by distance and may include telephone lines, frame relay, and ISDN. It is therefore costly to communicate globally. The growth of the Internet has provided an extensive backbone for global communications; however, the Internet does not provide intrinsic security measures. Combining the Internet with Virtual Private Network technology, which encrypts and authenticates data, creates a secure and potentially cost-effective data transmission path, as well as achieving other benefits such as reliability and scalability. Access to the Internet can be achieved by connecting to a local Internet Service Provider, which can be preferable to installing a static link between two distant points. The cost-effectiveness of the Internet-based Virtual Private Network is dependent on such factors as data amount, current operational costs, and the specifics of the Internet connection, such as user proximity to an Internet Service Provider or existing access to the Internet. This paper will introduce Virtual Private Network technology, the benefits of Internet communication, and the emergence of Internet-based Virtual Private Networks throughout the International Safeguards community. Specific projects to be discussed include: The completed demonstration of secure remote monitoring data transfer via the Internet between STUK in Helsinki, Finland, and the IAEA in Vienna, Austria; The demonstration of secure remote access to IAEA resources by traveling inspectors with Virtual Private Network software loaded on laptops; The proposed Action Sheets between ABACC/DOE and ARN/DOE, which will provide a link between Rio de Janeiro and Buenos Aires; The proposed use at the HIFAR research reactor, located in Australia, to provide remote monitoring data to the IAEA; The use of Virtual Private Networks by JRC, Ispra, Italy. (author)

  2. Game-Based Virtual Reality Canoe Paddling Training to Improve Postural Balance and Upper Extremity Function: A Preliminary Randomized Controlled Study of 30 Patients with Subacute Stroke.

    Science.gov (United States)

    Lee, Myung Mo; Lee, Kyeong Jin; Song, Chang Ho

    2018-04-27

    BACKGROUND Virtual reality (VR) training with motion-controlled console games can be incorporated into stroke rehabilitation programs. The use of a variety of gaming software can provide the patient with an opportunity to perform activities that are exciting, entertaining, and that may not be feasible in clinical environments. The aim of this preliminary randomized controlled study was to investigate the effects of game-based VR canoe paddling training, when combined with conventional physical rehabilitation programs, on postural balance and upper extremity function in 30 patients with subacute stroke. MATERIAL AND METHODS Thirty patients, who were within six months following the diagnosis of stroke, were randomly allocated to either the experimental group (n=15) or the control group (n=15). All participants participated in a conventional rehabilitation program. Also, the experimental group (n=15) performed the VR canoe paddling training for 30 minutes each day, three times per week, for five weeks. After five weeks, outcomes of changes in postural balance and upper extremity function were evaluated and compared between the two groups. RESULTS At five weeks, postural balance and upper extremity function showed significant improvements in both patients groups when compared with the baseline measurements (pGame-based VR canoe paddling training is an effective rehabilitation therapy that enhances postural balance and upper extremity function in patients with subacute stroke when combined with conventional physical rehabilitation programs.

  3. Changes of pelvis control with subacute stroke: A comparison of body-weight- support treadmill training coupled virtual reality system and over-ground training.

    Science.gov (United States)

    Mao, Yurong; Chen, Peiming; Li, Lifang; Li, Le; Huang, Dongfeng

    2015-01-01

    Gait recovery is very important to stroke survivors to regain their independence in activity of daily life. This study aimed to investigate the effects of virtual reality (VR) coupled body weight support treadmill training (BWSTT) on pelvic control at the early stage of stroke. Kinematic and kinetic changes of pelvic motion were evaluated by a 3D gait analysis system and were compared to the results from over-ground walking training. Twenty-four patients having unilateral hemiplegia with subacute stroke were recruited to a VR coupled BWSTT group (n= 12) and a conventional therapy (CT) group (n= 12). Both of the groups received training of 20-40 min/day, 5 days/week, for 3 weeks. The results showed the tilt of pelvis in sagittal plane improved significantly (P= 0.038) after treatment in the BWSTT+VR group, in terms of decreased amplitude of anterior peak (mean, from 10.99° to 6.25°), while there were no significant differences in the control group. The findings suggested that VR coupled BWSTT gait training could decrease anterior tilt of pelvis in early hemiparetic persons following a modest intervention dose, and the training may have advantages over conventional over-ground gait training and can assist the therapists in correcting abnormal gait pattern of stroke survivors.

  4. Breaststroke swimmers moderate internal work increases toward the highest stroke frequencies.

    Science.gov (United States)

    Lauer, Jessy; Olstad, Bjørn Harald; Minetti, Alberto Enrico; Kjendlie, Per-Ludvik; Rouard, Annie Hélène

    2015-09-18

    A model to predict the mechanical internal work of breaststroke swimming was designed. It allowed us to explore the frequency-internal work relationship in aquatic locomotion. Its accuracy was checked against internal work values calculated from kinematic sequences of eight participants swimming at three different self-chosen paces. Model predictions closely matched experimental data (0.58 ± 0.07 vs 0.59 ± 0.05 J kg(-1)m(-1); t(23)=-0.30, P=0.77), which was reflected in a slope of the major axis regression between measured and predicted total internal work whose 95% confidence intervals included the value of 1 (β=0.84, [0.61, 1.07], N=24). The model shed light on swimmers ability to moderate the increase in internal work at high stroke frequencies. This strategy of energy minimization has never been observed before in humans, but is present in quadrupedal and octopedal animal locomotion. This was achieved through a reduced angular excursion of the heaviest segments (7.2 ± 2.9° and 3.6 ± 1.5° for the thighs and trunk, respectively, Paquatic movements. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Rehabilitation that incorporates virtual reality is more effective than standard rehabilitation for improving walking speed, balance and mobility after stroke: a systematic review

    Directory of Open Access Journals (Sweden)

    Davide Corbetta

    2015-07-01

    Full Text Available Question: In people after stroke, does virtual reality based rehabilitation (VRBR improve walking speed, balance and mobility more than the same duration of standard rehabilitation? In people after stroke, does adding extra VRBR to standard rehabilitation improve the effects on gait, balance and mobility? Design: Systematic review with meta-analysis of randomised trials. Participants: Adults with a clinical diagnosis of stroke. Intervention: Eligible trials had to include one these comparisons: VRBR replacing some or all of standard rehabilitation or VRBR used as extra rehabilitation time added to a standard rehabilitation regimen. Outcome measures: Walking speed, balance, mobility and adverse events. Results: In total, 15 trials involving 341 participants were included. When VRBR replaced some or all of the standard rehabilitation, there were statistically significant benefits in walking speed (MD 0.15 m/s, 95% CI 0.10 to 0.19, balance (MD 2.1 points on the Berg Balance Scale, 95% CI 1.8 to 2.5 and mobility (MD 2.3 seconds on the Timed Up and Go test, 95% CI 1.2 to 3.4. When VRBR was added to standard rehabilitation, mobility showed a significant benefit (0.7 seconds on the Timed Up and Go test, 95% CI 0.4 to 1.1, but insufficient evidence was found to comment about walking speed (one trial and balance (high heterogeneity. Conclusion: Substituting some or all of a standard rehabilitation regimen with VRBR elicits greater benefits in walking speed, balance and mobility in people with stroke. Although the benefits are small, the extra cost of applying virtual reality to standard rehabilitation is also small, especially when spread over many patients in a clinic. Adding extra VRBR time to standard rehabilitation also has some benefits; further research is needed to determine if these benefits are clinically worthwhile. [Corbetta D, Imeri F, Gatti R (2015 Rehabilitation that incorporates virtual reality is more effective than standard

  6. Dual-Energy Computed Tomography in Stroke Imaging: Technical and Clinical Considerations of Virtual Noncontrast Images for Detection of the Hyperdense Artery Sign.

    Science.gov (United States)

    Winklhofer, Sebastian; Vittoria De Martini, Ilaria; Nern, Chrisitian; Blume, Iris; Wegener, Susanne; Pangalu, Athina; Valavanis, Antonios; Alkadhi, Hatem; Guggenberger, Roman

    The technical feasibility of virtual noncontrast (VNC) images from dual-energy computed tomography (DECT) for the detection of the hyperdense artery sign (HAS) in ischemic stroke patients was investigated. True noncontrast (TNC) scans of 60 patients either with or without HAS (n = 30 each) were investigated. Clot presence and characteristics were assessed on VNC images from DECT angiography and compared with TNC images. Clot characterization included the level of confidence for diagnosing HAS, a qualitative clot burden score, and quantitative attenuation (Hounsfield unit [HU]) measurements. Sensitivity, specificity, and accuracy of VNC for diagnosing HAS were 97%, 90%, and 93%, respectively. No significant differences were found regarding the diagnostic confidence (P = 0.18) and clot burden score (P = 0.071). No significant HU differences were found among vessels with HAS in VNC (56 ± 7HU) and TNC (57 ± 8HU) (P = 0.691) images. Virtual noncontrast images derived from DECT enable an accurate detection and characterization of HAS.

  7. Intelligent Virtual Agents : 9th International Conference, IVA 2009 Amsterdam, The Netherlands, September 14-16, 2009 Proceedings

    NARCIS (Netherlands)

    Ruttkay, Z.M.; Kipp, M.; Nijholt, Antinus; Vilhjalmsson, H.H.

    2009-01-01

    Welcome to the Proceedings of the 9th International Conference on Intelligent Virtual Agents, held 14-16 September, 2009 in Amsterdam, The Netherlands. Intelligent Virtual Agents (IVAs) are interactive characters that exhibit humanlike qualities and communicate with humans or with each other using

  8. Update on the third international stroke trial (IST-3 of thrombolysis for acute ischaemic stroke and baseline features of the 3035 patients recruited

    Directory of Open Access Journals (Sweden)

    Sandercock Peter

    2011-11-01

    Full Text Available Abstract Background Intravenous recombinant tissue plasminogen activator (rtPA is approved in Europe for use in patients with acute ischaemic stroke who meet strictly defined criteria. IST-3 sought to improve the external validity and precision of the estimates of the overall treatment effects (efficacy and safety of rtPA in acute ischaemic stroke, and to determine whether a wider range of patients might benefit. Design International, multi-centre, prospective, randomized, open, blinded endpoint (PROBE trial of intravenous rtPA in acute ischaemic stroke. Suitable patients had to be assessed and able to start treatment within 6 hours of developing symptoms, and brain imaging must have excluded intracranial haemorrhage and stroke mimics. Results The initial pilot phase was double blind and then, on 01/08/2003, changed to an open design. Recruitment began on 05/05/2000 and closed on 31/07/2011, by which time 3035 patients had been included, only 61 (2% of whom met the criteria for the 2003 European approval for thrombolysis. 1617 patients were aged over 80 years at trial entry. The analysis plan will be finalised, without reference to the unblinded data, and published before the trial data are unblinded in early 2012. The main trial results will be presented at the European Stroke Conference in Lisbon in May 2012 with the aim to publish simultaneously in a peer-reviewed journal. The trial result will be presented in the context of an updated Cochrane systematic review. We also intend to include the trial data in an individual patient data meta-analysis of all the relevant randomised trials. Conclusion The data from the trial will: improve the external validity and precision of the estimates of the overall treatment effects (efficacy and safety of iv rtPA in acute ischaemic stroke; provide: new evidence on the balance of risk and benefit of intravenous rtPA among types of patients who do not clearly meet the terms of the current EU approval; and

  9. Stenting of the cervical internal carotid artery in acute stroke management: The Karolinska experience.

    Science.gov (United States)

    Mpotsaris, Anastasios; Kabbasch, Christoph; Borggrefe, Jan; Gontu, Vamsi; Soderman, Michael

    2017-04-01

    Background Emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy is a routine procedure. Yet, precise indications and clinical safety in this setting remains controversial. Present data for mechanical thrombectomy include few studies with acute stenting of tandem occlusions. We evaluated the feasibility, safety and clinical outcome of this endovascular treatment in a retrospective analysis of all consecutive cases at a comprehensive stroke centre. Methods This was a retrospective analysis of all consecutive patients with acute extracranial carotid artery occlusion including acute dissection or high-grade stenosis and concomitant intracranial large-vessel occlusion treated with emergency carotid stenting and intracranial mechanical thrombectomy between November 2007 and May 2015. Results A total of 63 patients with a median age of 67 years (range 33-84 years) were treated. Of these, 33 (52%) patients had concomitant intravenous thrombolysis with recombinant tissue-type plasminogen activator initially. Median admission National Institutes of Health Stroke Scale was 14 (range 1-29). Median time from stroke onset to recanalization was 408 minutes (range 165-1846 minutes). Procedure time was significantly shorter after intravenous thrombolysis (110 minutes [range 15-202 minutes] vs. 130 minutes [range 60-280 minutes]; p = 0.02). Three (5%) patients experienced post-procedural symptomatic intracerebral haemorrhage. In 55/63 (87%) patients, a score of ≥2b on the Thrombolysis in Cerebral Infarction scale could be achieved. Eight (13%) patients died, five (8%) during the acute phase. A total of 29/63 (46%) patients showed a favourable outcome (modified Rankin Scale score of 0-2) after three months. Conclusions Our single-centre retrospective analysis of emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy demonstrated high

  10. The Combined Effects of Adaptive Control and Virtual Reality on Robot-Assisted Fine Hand Motion Rehabilitation in Chronic Stroke Patients: A Case Study.

    Science.gov (United States)

    Huang, Xianwei; Naghdy, Fazel; Naghdy, Golshah; Du, Haiping; Todd, Catherine

    2018-01-01

    Robot-assisted therapy is regarded as an effective and reliable method for the delivery of highly repetitive training that is needed to trigger neuroplasticity following a stroke. However, the lack of fully adaptive assist-as-needed control of the robotic devices and an inadequate immersive virtual environment that can promote active participation during training are obstacles hindering the achievement of better training results with fewer training sessions required. This study thus focuses on these research gaps by combining these 2 key components into a rehabilitation system, with special attention on the rehabilitation of fine hand motion skills. The effectiveness of the proposed system is tested by conducting clinical trials on a chronic stroke patient and verified through clinical evaluation methods by measuring the key kinematic features such as active range of motion (ROM), finger strength, and velocity. By comparing the pretraining and post-training results, the study demonstrates that the proposed method can further enhance the effectiveness of fine hand motion rehabilitation training by improving finger ROM, strength, and coordination. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  11. Neural Patterns of Reorganization after Intensive Robot-Assisted Virtual Reality Therapy and Repetitive Task Practice in Patients with Chronic Stroke

    Directory of Open Access Journals (Sweden)

    Soha Saleh

    2017-09-01

    Full Text Available Several approaches to rehabilitation of the hand following a stroke have emerged over the last two decades. These treatments, including repetitive task practice (RTP, robotically assisted rehabilitation and virtual rehabilitation activities, produce improvements in hand function but have yet to reinstate function to pre-stroke levels—which likely depends on developing the therapies to impact cortical reorganization in a manner that favors or supports recovery. Understanding cortical reorganization that underlies the above interventions is therefore critical to inform how such therapies can be utilized and improved and is the focus of the current investigation. Specifically, we compare neural reorganization elicited in stroke patients participating in two interventions: a hybrid of robot-assisted virtual reality (RAVR rehabilitation training and a program of RTP training. Ten chronic stroke subjects participated in eight 3-h sessions of RAVR therapy. Another group of nine stroke subjects participated in eight sessions of matched RTP therapy. Functional magnetic resonance imaging (fMRI data were acquired during paretic hand movement, before and after training. We compared the difference between groups and sessions (before and after training in terms of BOLD intensity, laterality index of activation in sensorimotor areas, and the effective connectivity between ipsilesional motor cortex (iMC, contralesional motor cortex, ipsilesional primary somatosensory cortex (iS1, ipsilesional ventral premotor area (iPMv, and ipsilesional supplementary motor area. Last, we analyzed the relationship between changes in fMRI data and functional improvement measured by the Jebsen Taylor Hand Function Test (JTHFT, in an attempt to identify how neurophysiological changes are related to motor improvement. Subjects in both groups demonstrated motor recovery after training, but fMRI data revealed RAVR-specific changes in neural reorganization patterns. First, BOLD

  12. Neural Patterns of Reorganization after Intensive Robot-Assisted Virtual Reality Therapy and Repetitive Task Practice in Patients with Chronic Stroke.

    Science.gov (United States)

    Saleh, Soha; Fluet, Gerard; Qiu, Qinyin; Merians, Alma; Adamovich, Sergei V; Tunik, Eugene

    2017-01-01

    Several approaches to rehabilitation of the hand following a stroke have emerged over the last two decades. These treatments, including repetitive task practice (RTP), robotically assisted rehabilitation and virtual rehabilitation activities, produce improvements in hand function but have yet to reinstate function to pre-stroke levels-which likely depends on developing the therapies to impact cortical reorganization in a manner that favors or supports recovery. Understanding cortical reorganization that underlies the above interventions is therefore critical to inform how such therapies can be utilized and improved and is the focus of the current investigation. Specifically, we compare neural reorganization elicited in stroke patients participating in two interventions: a hybrid of robot-assisted virtual reality (RAVR) rehabilitation training and a program of RTP training. Ten chronic stroke subjects participated in eight 3-h sessions of RAVR therapy. Another group of nine stroke subjects participated in eight sessions of matched RTP therapy. Functional magnetic resonance imaging (fMRI) data were acquired during paretic hand movement, before and after training. We compared the difference between groups and sessions (before and after training) in terms of BOLD intensity, laterality index of activation in sensorimotor areas, and the effective connectivity between ipsilesional motor cortex (iMC), contralesional motor cortex, ipsilesional primary somatosensory cortex (iS1), ipsilesional ventral premotor area (iPMv), and ipsilesional supplementary motor area. Last, we analyzed the relationship between changes in fMRI data and functional improvement measured by the Jebsen Taylor Hand Function Test (JTHFT), in an attempt to identify how neurophysiological changes are related to motor improvement. Subjects in both groups demonstrated motor recovery after training, but fMRI data revealed RAVR-specific changes in neural reorganization patterns. First, BOLD signal in multiple

  13. Facilitating learning through an international virtual collaborative practice: A case study.

    Science.gov (United States)

    Wihlborg, Monne; Friberg, Elizabeth E; Rose, Karen M; Eastham, Linda

    2018-02-01

    Internationalisation of higher education involving information and communication technology such as e-learning opens opportunities for innovative learning approaches across nations and cultures. Describe a case in practice of collaborative and transformative learning in relation to 'internationalisation on home grounds' with the broader learning objective of 'becoming aware and knowledgeable'. A mutually developed project established a virtual international collaborative exchange for faculty and students using a course management software (MOODLE) and open access technology (Adobe CONNECT). Two research universities in Sweden and the United States. Approximately 90 nursing students from each university per semester over several semesters. A collaborative process to develop a joint learning community to construct a virtual module and learning activity involving academics and nursing students in two countries using principles of meaning construction and negotiated learning. Developed possibilities for dealing with the challenges and finding strategies for a future higher education system that opens dialogues worldwide. Virtual international exchanges open innovative communication and learning contexts across nations and cultures. Internationalisation is so much more than students and teachers' mobility. 'Internationalisation on home grounds' (internationalisation for all) should receive more attention to support faculty and student collaboration, learning, and professional development. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Closed-loop task difficulty adaptation during virtual reality reach-to-grasp training assisted with an exoskeleton for stroke rehabilitation

    Directory of Open Access Journals (Sweden)

    Florian Grimm

    2016-11-01

    Full Text Available Stroke patients with severe motor deficits of the upper extremity may practice rehabilitation exercises with the assistance of a multi-joint exoskeleton. Although this technology enables intensive task-oriented training, it may also lead to slacking when the assistance is too supportive. Preserving the engagement of the patients while providing assistance-as-needed during the exercises, therefore remains an ongoing challenge.We applied a commercially available seven degree-of-freedom arm exoskeleton to provide passive gravity compensation during task-oriented training in a virtual environment. During this four-week pilot study, five severely affected chronic stroke patients performed reach-to-grasp exercises resembling activities of daily living. The subjects received virtual reality feedback from their three-dimensional movements. The level of difficulty for the exercise was adjusted by a performance-dependent real-time adaptation algorithm. The goal of this algorithm was the automated improvement of the range of motion. In the course of 20 training and feedback sessions, this unsupervised adaptive training concept led to a progressive increase of the virtual training space (p<0.001 in accordance with the subjects’ abilities. This learning curve was paralleled by a concurrent improvement of real world kinematic parameters, i.e., range of motion (p=0.008, accuracy of movement (p=0.01, and movement velocity (p<0.001. Notably, these kinematic gains were paralleled by motor improvements such as increased elbow movement (p=0.001, grip force (p<0.001, and upper extremity Fugl-Meyer-Assessment score from 14.3 ± 5 to 16.9 ± 6.1 (p=0.026.Combining gravity-compensating assistance with adaptive closed-loop feedback in virtual reality provides customized rehabilitation environments for severely affected stroke patients. This approach may facilitate motor learning by progressively challenging the subject in accordance with the individual capacity for

  15. Assessment of test-retest reliability and internal consistency of the Wisconsin Gait Scale in hemiparetic post-stroke patients

    Directory of Open Access Journals (Sweden)

    Guzik Agnieszka

    2016-09-01

    Full Text Available Introduction: A proper assessment of gait pattern is a significant aspect in planning the process of teaching gait in hemiparetic post-stroke patients. The Wisconsin Gait Scale (WGS is an observational tool for assessing post-stroke patients’ gait. The aim of the study was to assess test-retest reliability and internal consistency of the WGS and examine correlations between gait assessment made with the WGS and gait speed, Brunnström scale, Ashworth’s scale and the Barthel Index.

  16. Maximizing post-stroke upper limb rehabilitation using a novel telerehabilitation interactive virtual reality system in the patient's home: study protocol of a randomized clinical trial.

    Science.gov (United States)

    Kairy, Dahlia; Veras, Mirella; Archambault, Philippe; Hernandez, Alejandro; Higgins, Johanne; Levin, Mindy F; Poissant, Lise; Raz, Amir; Kaizer, Franceen

    2016-03-01

    Telerehabilitation (TR), or the provision of rehabilitation services from a distance using telecommunication tools such as the Internet, can contribute to ensure that patients receive the best care at the right time. This study aims to assess the effect of an interactive virtual reality (VR) system that allows ongoing rehabilitation of the upper extremity (UE) following a stroke, while the person is in their own home, with offline monitoring and feedback from a therapist at a distance. A single-blind (evaluator is blind to group assignment) two-arm randomized controlled trial is proposed, with participants who have had a stroke and are no longer receiving rehabilitation services randomly allocated to: (1) 4-week written home exercise program, i.e. usual care discharge home program or (2) a 4-week home-based TR exercise program using VR in addition to usual care i.e. treatment group. Motor recovery of the UE will be assessed using the Fugl-Meyer Assessment-UE and the Box and Block tests. To determine the efficacy of the system in terms of functional recovery, the Motor Activity Log, a self-reported measure of UE use will be used. Impact on quality of life will be determined using the Stroke Impact Scale-16. Lastly, a preliminary cost-effectiveness analysis will be conducted using costs and outcomes for all groups. Findings will contribute to evidence regarding the use of TR and VR to provide stroke rehabilitation services from a distance. This approach can enhance continuity of care once patients are discharged from rehabilitation, in order to maximize their recovery beyond the current available services. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Intensive virtual reality-based training for upper limb motor function in chronic stroke: a feasibility study using a single case experimental design and fMRI.

    Science.gov (United States)

    Schuster-Amft, Corina; Henneke, Andrea; Hartog-Keisker, Birgit; Holper, Lisa; Siekierka, Ewa; Chevrier, Edith; Pyk, Pawel; Kollias, Spyros; Kiper, Daniel; Eng, Kynan

    2015-01-01

    To evaluate feasibility and neurophysiological changes after virtual reality (VR)-based training of upper limb (UL) movements. Single-case A-B-A-design with two male stroke patients (P1:67 y and 50 y, 3.5 and 3 y after onset) with UL motor impairments, 45-min therapy sessions 5×/week over 4 weeks. Patients facing screen, used bimanual data gloves to control virtual arms. Three applications trained bimanual reaching, grasping, hand opening. Assessments during 2-week baseline, weekly during intervention, at 3-month follow-up (FU): Goal Attainment Scale (GAS), Chedoke Arm and Hand Activity Inventory (CAHAI), Chedoke-McMaster Stroke Assessment (CMSA), Extended Barthel Index (EBI), Motor Activity Log (MAL). Functional magnetic resonance imaging scans (FMRI) before, immediately after treatment and at FU. P1 executed 5478 grasps (paretic arm). Improvements in CAHAI (+4) were maintained at FU. GAS changed to +1 post-test and +2 at FU. P2 executed 9835 grasps (paretic arm). CAHAI improvements (+13) were maintained at FU. GAS scores changed to -1 post-test and +1 at FU. MAL scores changed from 3.7 at pre-test to 5.5 post-test and 3.3 at FU. The VR-based intervention was feasible, safe, and intense. Adjustable application settings maintained training challenge and patient motivation. ADL-relevant UL functional improvements persisted at FU and were related to changed cortical activation patterns. Implications for Rehabilitation YouGrabber trains uni- and bimanual upper motor function. Its application is feasible, safe, and intense. The control of the virtual arms can be done in three main ways: (a) normal (b) virtual mirror therapy, or (c) virtual following. The mirroring feature provides an illusion of affected limb movements during the period when the affected upper limb (UL) is resting. The YouGrabber training led to ADL-relevant UL functional improvements that were still assessable 12 weeks after intervention finalization and were related to changed cortical

  18. Efficacy and safety of non-immersive virtual reality exercising in stroke rehabilitation (EVREST): a randomised, multicentre, single-blind, controlled trial.

    Science.gov (United States)

    Saposnik, Gustavo; Cohen, Leonardo G; Mamdani, Muhammad; Pooyania, Sepideth; Ploughman, Michelle; Cheung, Donna; Shaw, Jennifer; Hall, Judith; Nord, Peter; Dukelow, Sean; Nilanont, Yongchai; De Los Rios, Felipe; Olmos, Lisandro; Levin, Mindy; Teasell, Robert; Cohen, Ashley; Thorpe, Kevin; Laupacis, Andreas; Bayley, Mark

    2016-09-01

    Non-immersive virtual reality is an emerging strategy to enhance motor performance for stroke rehabilitation. There has been rapid adoption of non-immersive virtual reality as a rehabilitation strategy despite the limited evidence about its safety and effectiveness. Our aim was to compare the safety and efficacy of virtual reality with recreational therapy on motor recovery in patients after an acute ischaemic stroke. In this randomised, controlled, single-blind, parallel-group trial we enrolled adults (aged 18-85 years) who had a first-ever ischaemic stroke and a motor deficit of the upper extremity score of 3 or more (measured with the Chedoke-McMaster scale) within 3 months of randomisation from 14 in-patient stroke rehabilitation units from four countries (Canada [11], Argentina [1], Peru [1], and Thailand [1]). Participants were randomly allocated (1:1) by a computer-generated assignment at enrolment to receive a programme of structured, task-oriented, upper extremity sessions (ten sessions, 60 min each) of either non-immersive virtual reality using the Nintendo Wii gaming system (VRWii) or simple recreational activities (playing cards, bingo, Jenga, or ball game) as add-on therapies to conventional rehabilitation over a 2 week period. All investigators assessing outcomes were masked to treatment assignment. The primary outcome was upper extremity motor performance measured by total time to complete the Wolf Motor Function Test (WMFT) at the end of the 2 week intervention period, analysed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NTC01406912. The study was done between May 12, 2012, and Oct 1, 2015. We randomly assigned 141 patients: 71 received VRWii therapy and 70 received recreational activity. 121 (86%) patients (59 in the VRWii group and 62 in the recreational activity group) completed the final assessment and were included in the primary analysis. Each group improved WMFT performance time relative to

  19. Measuring Scaling Effects in Small Two-Stroke Internal Combustion Engines

    Science.gov (United States)

    2014-06-20

    was used [9]. Compression ignition (CI) engines rely on auto - ignition to initiate combustion during an engine cycle. During intake, only air flows...9 Figure 2: Four-stroke IC engine cycle. (a) Intake stroke (b) Compression stroke (c) Ignition (d) Power...CAD crank angle degrees CI compression ignition COTS commercial off the shelf CoV coefficient of variance DAQ data acquisition system DI

  20. Stay Focused! The Effects of Internal and External Focus of Attention on Movement Automaticity in Patients with Stroke

    Science.gov (United States)

    Kal, E. C.; van der Kamp, J.; Houdijk, H.; Groet, E.; van Bennekom, C. A. M.; Scherder, E. J. A.

    2015-01-01

    Dual-task performance is often impaired after stroke. This may be resolved by enhancing patients’ automaticity of movement. This study sets out to test the constrained action hypothesis, which holds that automaticity of movement is enhanced by triggering an external focus (on movement effects), rather than an internal focus (on movement execution). Thirty-nine individuals with chronic, unilateral stroke performed a one-leg-stepping task with both legs in single- and dual-task conditions. Attentional focus was manipulated with instructions. Motor performance (movement speed), movement automaticity (fluency of movement), and dual-task performance (dual-task costs) were assessed. The effects of focus on movement speed, single- and dual-task movement fluency, and dual-task costs were analysed with generalized estimating equations. Results showed that, overall, single-task performance was unaffected by focus (p = .341). Regarding movement fluency, no main effects of focus were found in single- or dual-task conditions (p’s ≥ .13). However, focus by leg interactions suggested that an external focus reduced movement fluency of the paretic leg compared to an internal focus (single-task conditions: p = .068; dual-task conditions: p = .084). An external focus also tended to result in inferior dual-task performance (β = -2.38, p = .065). Finally, a near-significant interaction (β = 2.36, p = .055) suggested that dual-task performance was more constrained by patients’ attentional capacity in external focus conditions. We conclude that, compared to an internal focus, an external focus did not result in more automated movements in chronic stroke patients. Contrary to expectations, trends were found for enhanced automaticity with an internal focus. These findings might be due to patients’ strong preference to use an internal focus in daily life. Future work needs to establish the more permanent effects of learning with different attentional foci on re-automating motor

  1. Stay Focused! The Effects of Internal and External Focus of Attention on Movement Automaticity in Patients with Stroke.

    Science.gov (United States)

    Kal, E C; van der Kamp, J; Houdijk, H; Groet, E; van Bennekom, C A M; Scherder, E J A

    2015-01-01

    Dual-task performance is often impaired after stroke. This may be resolved by enhancing patients' automaticity of movement. This study sets out to test the constrained action hypothesis, which holds that automaticity of movement is enhanced by triggering an external focus (on movement effects), rather than an internal focus (on movement execution). Thirty-nine individuals with chronic, unilateral stroke performed a one-leg-stepping task with both legs in single- and dual-task conditions. Attentional focus was manipulated with instructions. Motor performance (movement speed), movement automaticity (fluency of movement), and dual-task performance (dual-task costs) were assessed. The effects of focus on movement speed, single- and dual-task movement fluency, and dual-task costs were analysed with generalized estimating equations. Results showed that, overall, single-task performance was unaffected by focus (p = .341). Regarding movement fluency, no main effects of focus were found in single- or dual-task conditions (p's ≥ .13). However, focus by leg interactions suggested that an external focus reduced movement fluency of the paretic leg compared to an internal focus (single-task conditions: p = .068; dual-task conditions: p = .084). An external focus also tended to result in inferior dual-task performance (β = -2.38, p = .065). Finally, a near-significant interaction (β = 2.36, p = .055) suggested that dual-task performance was more constrained by patients' attentional capacity in external focus conditions. We conclude that, compared to an internal focus, an external focus did not result in more automated movements in chronic stroke patients. Contrary to expectations, trends were found for enhanced automaticity with an internal focus. These findings might be due to patients' strong preference to use an internal focus in daily life. Future work needs to establish the more permanent effects of learning with different attentional foci on re-automating motor control

  2. Managing International Consulting Projects and International Business Courses Using Virtual Teams

    Science.gov (United States)

    Prachyl, Cheryl; Quintanilla, Hector; Gutiérrez, Luis Antonio

    2011-01-01

    The Instituto Tecnologico y de Estudios Superiores de Monterrey and Texas Wesleyan University used technology based courses to enhance internationalization of their curricula. These courses required students to use computer technology as the distance communication medium and to complete an applied international consulting project as part of each…

  3. Social Media and Population Health Virtual Exchange for Senior Nursing Students: An International Collaboration.

    Science.gov (United States)

    Procter, Paula M; Brixey, Juliana J; Honey, Michelle L L; Todhunter, Fern

    2016-01-01

    The authors have all engaged in using social media with students as a means for collaboration across national and international boundaries for various educational purposes. Following the explosion of big data in health the authors are now moving this concept forward within undergraduate and postgraduate nursing curricula for the development of population health virtual exchanges. Nursing has a global presence and yet it appears as though students have little knowledge of the health and social care needs and provision outside their local environment. This development will allow for explorative exchange amongst students in three countries, enhancing their understanding of their own and the selected international population health needs and solutions through asking and responding to questions amongst the learning community involved. The connection of the students will be recorded for their use in reflection; of particular interest will be the use of information included by the students to answer questions about their locality.

  4. Effects of game-based virtual reality on health-related quality of life in chronic stroke patients: A randomized, controlled study.

    Science.gov (United States)

    Shin, Joon-Ho; Bog Park, Si; Ho Jang, Seong

    2015-08-01

    In the present study, we aimed to determine whether game-based virtual reality (VR) rehabilitation, combined with occupational therapy (OT), could improve health-related quality of life, depression, and upper extremity function. We recruited 35 patients with chronic hemiparetic stroke, and these participants were randomized into groups that underwent VR rehabilitation plus conventional OT, or the same amount of conventional OT alone, for 20 sessions over 4 weeks. Compared to baseline, the VR rehabilitation plus OT group exhibited significantly improved role limitation due to emotional problems (p=0.047). Compared to baseline, both groups also exhibited significantly improved depression (p=0.017) and upper extremity function (p=0.001), although the inter-group differences were not significant. However, a significant inter-group difference was observed for role limitation due to physical problems (p=0.031). Our results indicate that game-based VR rehabilitation has specific effects on health-related quality of life, depression, and upper extremity function among patients with chronic hemiparetic stroke. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. VObs.it, the Italian contribution to the international Virtual Observatory-History, activities, strategy

    Science.gov (United States)

    Pasian, F.

    2015-06-01

    The origins of the Italian contribution to the international Virtual Observatory (VO) were mainly tied to the definition and implementation of a Data Grid using Grid standards. From there on, by means of a step-wise evolution, activities started including the implementation of VO-aware tools and facilities, or the production of services accessing data archives in ways compliant to the international VO standards. An important activity the Italian VO community has carried out is the dissemination of the VO capabilities to professionals, students and amateurs: in particular, an important and maybe unique success has been bringing to the classrooms the VO, and using it as a powerful tool to teach astronomy at all levels, from junior high school to undergraduate courses. Lately, there has been also direct involvement of the Italian community in the definition of standards and services within the framework of the International Virtual Observatory Alliance (IVOA), and participation and leadership in the IVOA Working Groups. Along this path, the national funding for these activities has been rather low, although essential to carry the activities on. There were no bursts of funding to allow a quick rise in activities leading to the fast realisation of tools and systems. Rather, the manpower involved in VObs.it has been always fairly low but steady. In the view of managing a national VO initiative with a low budget, strategic choices were made to exploit the available resources and to guarantee a constant background activity, mainly geared at providing services to the community, development in lower-priority VO areas, dissemination and support.

  6. The impact of positive, negative and neutral stimuli in a virtual reality cognitive-motor rehabilitation task: a pilot study with stroke patients.

    Science.gov (United States)

    Cameirão, Mónica S; Faria, Ana Lúcia; Paulino, Teresa; Alves, Júlio; Bermúdez I Badia, Sergi

    2016-08-09

    Virtual Reality (VR) based methods for stroke rehabilitation have mainly focused on motor rehabilitation, but there is increasing interest in integrating motor and cognitive training to increase similarity to real-world settings. Unfortunately, more research is needed for the definition of which type of content should be used in the design of these tools. One possibility is the use of emotional stimuli, which are known to enhance attentional processes. According to the Socioemotional Selectivity Theory, as people age, the emotional salience arises for positive and neutral, but not for negative stimuli. For this study we developed a cognitive-motor VR task involving attention and short-term memory, and we investigated the impact of using emotional images of varying valence. The task consisted of finding a target image, shown for only two seconds, among fourteen neutral distractors, and selecting it through arm movements. After performing the VR task, a recall task took place and the patients had to identify the target images among a valence-matched number of distractors. Ten stroke patients participated in a within-subjects experiment with three conditions based on the valence of the images: positive, negative and neutral. Eye movements were recorded during VR task performance with an eye tracking system. Our results show decreased attention for negative stimuli in the VR task performance when compared to neutral stimuli. The recall task shows significantly more wrongly identified images (false memories) for negative stimuli than for neutral. Regression and correlation analyses with the Montreal Cognitive Assessment and the Geriatric Depression Scale revealed differential effects of cognitive function and depressive symptomatology in the encoding and recall of positive, negative and neutral images. Further, eye movement data shows reduced search patterns for wrongly selected stimuli containing emotional content. The results of this study suggest that it is feasible

  7. 5th International Conference on Changeable, Agile, Reconfigurable and Virtual Production

    CERN Document Server

    2014-01-01

    The changing manufacturing environment requires more responsive and adaptable manufacturing systems. The theme of the 5th International Conference on Changeable, Agile, Reconfigurable and Virtual production (CARV2013) is "Enabling Manufacturing Competitiveness and Economic Sustainability. Leading edge research and best implementation practices and experiences, which address these important issues and challenges, are presented. The proceedings include advances in manufacturing systems design, planning, evaluation, control and evolving paradigms such as mass customization, personalization, changeability, re-configurability and flexibility. New and important concepts such as the dynamic product families and platforms, co-evolution of products and systems, and methods for enhancing manufacturing systems' economic sustainability and prolonging their life to produce more than one product generation are treated. Enablers of change in manufacturing systems, production volume and capability, scalability and managing t...

  8. Virtual reality exergaming as adjunctive therapy in a sub-acute stroke rehabilitation setting: facilitators and barriers.

    Science.gov (United States)

    Nguyen, Ai-Vi; Ong, Yau-Lok Austin; Luo, Cindy Xin; Thuraisingam, Thiviya; Rubino, Michael; Levin, Mindy F; Kaizer, Franceen; Archambault, Philippe S

    2018-03-12

    To identify the facilitators and barriers perceived by clinicians to using an Exergaming Room as adjunct to conventional therapy. Phenomenological qualitative study using an interpretive description methodology. Ten clinicians (four physical therapists, six occupational therapists) from the Stroke Program at the Jewish Rehabilitation Hospital (nine female, one male, age range 25-50 years old) who referred clients to the Exergaming Room. Ten to twenty minute semi-structured interviews were conducted with each clinician. Convenience sampling was used. A thematic analysis was performed on the data collected by grouping all the open codes into facilitators and barriers, and then categorized into levels, themes and subthemes. Facilitators and barriers were divided into three levels: organizational, individual and technological. Major facilitators at the organizational level were: institutional support; at the individual level: personal experience of referring clinician, presence of an expert clinician, and relevance of the Exergaming Room for stroke clients; and at the technological level: perceived ease of use of the exergames and possibility of providing additional therapy. Key barriers to successful implementation of the Exergaming Room at the organizational level were: scheduling difficulties and lack of staffing; at the individual level: client functional limitations; at the technological level: low precision in motion capture of the exergame systems. Multiple factors affect the implementation of new technology in rehabilitation settings. In order to successfully integrate exergame systems into practice, institutions are encouraged to take the identified factors (facilitators and barriers) into account. Implications for Rehabilitation Clinicians who have referred individuals with stroke to an "exergames" room over a 1-year period at a rehabilitation hospital have found the service to be highly relevant to their clients. The presence of an expert clinician, who

  9. Language and functionality of post-stroke adults: evaluation based on International Classification of Functioning, Disability and Health (ICF).

    Science.gov (United States)

    Santana, Maria Tereza Maynard; Chun, Regina Yu Shon

    2017-03-09

    Cerebrovascular accident is an important Public Health problem because of the high rates of mortality and sequelae such as language disorders. The conceptual health changes have led to the incorporation of functional and social aspects in the assessments as proposed by the World Health Organization in the International Classification of Functioning, Disability and Health. The purpose was to evaluate and classify language aspects, functionality and participation of post-stroke individuals based on the concepts of the International Classification of Functioning, Disability and Health and characterize the sociodemographic profile of participants. Data collection was carried out through the application of a clinical instrument to evaluate language, participation and functionality in fifty individuals based on the International Classification of Functioning, Disability and Health. The age of the participants varied between 32 and 88 years, and the majority were elderly men. Among body functions, the participants reported more difficulties in "memory functions". As for activity and participation, more difficulties were reported in "recreation and leisure". As for environmental factors, the component "healthcare professionals" was indicated as a facilitator by the majority of participants. The results show the impact of language difficulties in the lives of post-stroke adults and reinforce the applicability of the International Classification of Functioning, Disability and Health as an important complementary tool for assessing language, functionality and participation in a comprehensive and humane approach, towards the improvement of health assistance in ambulatory care.

  10. Content validation of the international classification of functioning, disability and health core set for stroke from gender perspective using a qualitative approach.

    Science.gov (United States)

    Glässel, A; Coenen, M; Kollerits, B; Cieza, A

    2014-06-01

    The extended ICF Core Set for stroke is an application of the International Classification of Functioning, Disability and Health (ICF) of the World Health Organisation (WHO) with the purpose to represent the typical spectrum of functioning of persons with stroke. The objective of the study is to add evidence to the content validity of the extended ICF Core Set for stroke from persons after stroke taking into account gender perspective. A qualitative study design was conducted by using individual interviews with women and men after stroke in an in- and outpatient rehabilitation setting. The sampling followed the maximum variation strategy. Sample size was determined by saturation. Concepts from qualitative data analysis were linked to ICF categories and compared to the extended ICF Core Set for stroke. Twelve women and 12 men participated in 24 individual interviews. In total, 143 out of 166 ICF categories included in the extended ICF Core Set for stroke were confirmed (women: N.=13; men: N.=17; both genders: N.=113). Thirty-eight additional categories that are not yet included in the extended ICF Core Set for stroke were raised by women and men. This study confirms that the experience of functioning and disability after stroke shows communalities and differences for women and men. The validity of the extended ICF Core Set for stroke could be mostly confirmed, since it does not only include those areas of functioning and disability relevant to both genders but also those exclusively relevant to either women or men. Further research is needed on ICF categories not yet included in the extended ICF Core Set for stroke.

  11. Pediatric Stroke

    Science.gov (United States)

    ... and Patient Resources Home » Patients & Families » About Stroke » Pediatric Stroke » Introduction Introduction What is a Stroke? Ischemic Stroke Intracerebral Hemorrhage Subarachnoid Hemorrhage Pediatric Stroke Introduction Types of Stroke Diagnosis and Treatment ...

  12. Virtual Worlds and Gamification to Increase Integration of International Students in Higher Education: An Inclusive Design Approach

    Science.gov (United States)

    Zhang, Bo; Robb, Nigel; Eyerman, Joe; Goodman, Lizbeth

    2017-01-01

    In response to the growing trend of internationalisation in education, it is important to consider approaches to help international students integrate in their new settings. One possible approach involves the use of e-Learning tools, such as virtual worlds and gamification. To maximise the potential effectiveness of such tools, it may be…

  13. VISTA-Rehab: a resource for stroke rehabilitation trials.

    Science.gov (United States)

    Ali, Myzoon; Ashburn, Ann; Bowen, Audrey; Brodie, Eric; Corr, Susan; Drummond, Avril; Edmans, Judi; Gladman, John; Kalra, Lalit; Langhorne, Peter; Lees, Kennedy R; Lincoln, Nadina; Logan, Pip; Mead, Gillian; Patchick, Emma; Pollock, Alex; Pomeroy, Val; Sackley, Catherine; Sunnerhagen, Katherina S; van Vliet, Paulette; Walker, Marion; Brady, Marian

    2010-12-01

    Stroke rehabilitation is a complex intervention. Many factors influence the interaction between the patient and the elements of the intervention. Rehabilitation interventions are aimed at altering different domains of patient outcome including body functions, activity and participation. As a consequence, randomised clinical trials in this area are difficult to design. We developed an archive of stroke rehabilitation trials (VISTA-Rehab) to act as a resource to help trialists model and design future rehabilitation studies. We developed specific eligibility criteria for the entry of stroke rehabilitation trials into the archive. We established a Steering Committee to oversee projects and publications and commenced the recruitment of rehabilitation trials into this resource. As of August 2009, VISTA-Rehab contains data from 23 stroke rehabilitation trials (>3400 patients). Demographic data, including age [median=73, interquartile range (63,79)], gender (male=53%) and initial dependency [median baseline Barthel index score=6, interquartile range (9,19)], are available for all patients. Outcome measures include the modified Rankin Scale, Barthel Index, Rivermead Motor Assessment, Fugl-Meyer Assessment, General Health Questionnaire and Nottingham Extended Activities of Daily Living Scale. VISTA-Rehab expands the Virtual International Stroke Trials Archive to include rehabilitation trials. Anonymised data can be used to examine questions specific to stroke rehabilitation and to generate novel hypotheses. © 2010 The Authors. International Journal of Stroke © 2010 World Stroke Organization.

  14. The Bobath Concept in Walking Activity in Chronic Stroke Measured Through the International Classification of Functioning, Disability and Health.

    Science.gov (United States)

    Benito García, Miguel; Atín Arratibel, María Ángeles; Terradillos Azpiroz, Maria Estíbaliz

    2015-12-01

    The aim of this study is to evaluate the effectiveness of a rehabilitation programme based on the Bobath concept in order to improve walking activity in patients with chronic stroke and to show the usefulness of the International Classification of Functioning, Disability and Health (ICF) as a tool for gathering functioning information. This study is a repeated measures study. The setting of this study is an outpatient neurological rehabilitation centre based on a multidisciplinary approach. Twenty-four participants suffering from chronic stroke (>1 year and a half and Bobath concept principles with three weekly individual physiotherapy sessions of 45 min each over a 6-month period was the intervention for this study. The measures used were Modified Emory Functional Ambulation Profile, 10-m walk test, 6-min walk test, muscle strength testing and subsequent codification of these results into ICF qualifiers. The results of the study showed significant improvement in activities of walking long distances, on different surfaces and around obstacles. There was no significant improvement in the activity of walking short distances or for muscle power functions. A rehabilitation programme based on the Bobath Concept improved walking activities in people with chronic stroke. For this intervention, the use of the ICF qualifiers was sensitive in perceiving post-treatment changes. Copyright © 2014 John Wiley & Sons, Ltd.

  15. Virtual Interactive Presence in Global Surgical Education: International Collaboration Through Augmented Reality.

    Science.gov (United States)

    Davis, Matthew Christopher; Can, Dang D; Pindrik, Jonathan; Rocque, Brandon G; Johnston, James M

    2016-02-01

    Technology allowing a remote, experienced surgeon to provide real-time guidance to local surgeons has great potential for training and capacity building in medical centers worldwide. Virtual interactive presence and augmented reality (VIPAR), an iPad-based tool, allows surgeons to provide long-distance, virtual assistance wherever a wireless internet connection is available. Local and remote surgeons view a composite image of video feeds at each station, allowing for intraoperative telecollaboration in real time. Local and remote stations were established in Ho Chi Minh City, Vietnam, and Birmingham, Alabama, as part of ongoing neurosurgical collaboration. Endoscopic third ventriculostomy with choroid plexus coagulation with VIPAR was used for subjective and objective evaluation of system performance. VIPAR allowed both surgeons to engage in complex visual and verbal communication during the procedure. Analysis of 5 video clips revealed video delay of 237 milliseconds (range, 93-391 milliseconds) relative to the audio signal. Excellent image resolution allowed the remote neurosurgeon to visualize all critical anatomy. The remote neurosurgeon could gesture to structures with no detectable difference in accuracy between stations, allowing for submillimeter precision. Fifteen endoscopic third ventriculostomy with choroid plexus coagulation procedures have been performed with the use of VIPAR between Vietnam and the United States, with no significant complications. 80% of these patients remain shunt-free. Evolving technologies that allow long-distance, intraoperative guidance, and knowledge transfer hold great potential for highly efficient international neurosurgical education. VIPAR is one example of an inexpensive, scalable platform for increasing global neurosurgical capacity. Efforts to create a network of Vietnamese neurosurgeons who use VIPAR for collaboration are underway. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Cerebral White Matter Hypoperfusion Increases with Small-Vessel Disease Burden. Data From the Third International Stroke Trial.

    Science.gov (United States)

    Arba, Francesco; Mair, Grant; Carpenter, Trevor; Sakka, Eleni; Sandercock, Peter A G; Lindley, Richard I; Inzitari, Domenico; Wardlaw, Joanna M

    2017-07-01

    Leukoaraiosis is associated with impaired cerebral perfusion, but the effect of individual and combined small-vessel disease (SVD) features on white matter perfusion is unclear. We studied patients recruited with perfusion imaging in the Third International Stroke Trial. We rated individual SVD features (leukoaraiosis, lacunes) and brain atrophy on baseline plain computed tomography or magnetic resonance imaging. Separately, we assessed white matter at the level of the lateral ventricles in the cerebral hemisphere contralateral to the stroke for visible areas of hypoperfusion (present or absent) on 4 time-based perfusion imaging parameters. We examined associations between SVD features (individually and summed) and presence of hypoperfusion using logistic regression adjusted for age, sex, baseline National Institutes of Health Stroke Scale, hypertension, and diabetes. A total of 115 patients with median (interquartile range) age of 81 (72-86) years, 78 (52%) of which were male, had complete perfusion data. Hypoperfusion was most frequent on mean transit time (MTT; 63 patients, 55%) and least frequent on time to maximum flow (19 patients, 17%). The SVD score showed stronger independent associations with hypoperfusion (e.g., MTT, odds ratio [OR] = 2.80; 95% confidence interval [CI] = 1.56-5.03) than individual SVD markers (e.g., white matter hypoattenuation score, MTT, OR = 1.49, 95% CI = 1.09-2.04). Baseline blood pressure did not differ by presence or absence of hypoperfusion or across strata of SVD score. Presence of white matter hypoperfusion increased with SVD summed score. The SVD summed score was associated with hypoperfusion more consistently than individual SVD features, providing validity to the SVD score concept. Increasing SVD burden indicates worse perfusion in the white matter. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  17. Using mixed methods to evaluate efficacy and user expectations of a virtual reality-based training system for upper-limb recovery in patients after stroke: a study protocol for a randomised controlled trial.

    Science.gov (United States)

    Schuster-Amft, Corina; Eng, Kynan; Lehmann, Isabelle; Schmid, Ludwig; Kobashi, Nagisa; Thaler, Irène; Verra, Martin L; Henneke, Andrea; Signer, Sandra; McCaskey, Michael; Kiper, Daniel

    2014-09-06

    In recent years, virtual reality has been introduced to neurorehabilitation, in particular with the intention of improving upper-limb training options and facilitating motor function recovery. The proposed study incorporates a quantitative part and a qualitative part, termed a mixed-methods approach: (1) a quantitative investigation of the efficacy of virtual reality training compared to conventional therapy in upper-limb motor function are investigated, (2a) a qualitative investigation of patients' experiences and expectations of virtual reality training and (2b) a qualitative investigation of therapists' experiences using the virtual reality training system in the therapy setting. At three participating clinics, 60 patients at least 6 months after stroke onset will be randomly allocated to an experimental virtual reality group (EG) or to a control group that will receive conventional physiotherapy or occupational therapy (16 sessions, 45 minutes each, over the course of 4 weeks). Using custom data gloves, patients' finger and arm movements will be displayed in real time on a monitor, and they will move and manipulate objects in various virtual environments. A blinded assessor will test patients' motor and cognitive performance twice before, once during, and twice after the 4-week intervention. The primary outcome measure is the Box and Block Test. Secondary outcome measures are the Chedoke-McMaster Stroke Assessments (hand, arm and shoulder pain subscales), the Chedoke-McMaster Arm and Hand Activity Inventory, the Line Bisection Test, the Stroke Impact Scale, the MiniMentalState Examination and the Extended Barthel Index. Semistructured face-to-face interviews will be conducted with patients in the EG after intervention finalization with a focus on the patients' expectations and experiences regarding the virtual reality training. Therapists' perspectives on virtual reality training will be reviewed in three focus groups comprising four to six occupational

  18. Cardiopulmonary resuscitation training in high school using avatars in virtual worlds: an international feasibility study.

    Science.gov (United States)

    Creutzfeldt, Johan; Hedman, Leif; Heinrichs, LeRoy; Youngblood, Patricia; Felländer-Tsai, Li

    2013-01-14

    Approximately 300,000 people suffer sudden cardiac arrest (SCA) annually in the United States. Less than 30% of out-of-hospital victims receive cardiopulmonary resuscitation (CPR) despite the American Heart Association training over 12 million laypersons annually to conduct CPR. New engaging learning methods are needed for CPR education, especially in schools. Massively multiplayer virtual worlds (MMVW) offer platforms for serious games that are promising learning methods that take advantage of the computer capabilities of today's youth (ie, the digital native generation). Our main aim was to assess the feasibility of cardiopulmonary resuscitation training in high school students by using avatars in MMVM. We also analyzed experiences, self-efficacy, and concentration in response to training. In this prospective international collaborative study, an e-learning method was used with high school students in Sweden and the United States. A software game platform was modified for use as a serious game to train in emergency medical situations. Using MMVW technology, participants in teams of 3 were engaged in virtual-world scenarios to learn how to treat victims suffering cardiac arrest. Short debriefings were carried out after each scenario. A total of 36 high school students (Sweden, n=12; United States, n=24) participated. Their self-efficacy and concentration (task motivation) were assessed. An exit questionnaire was used to solicit experiences and attitudes toward this type of training. Among the Swedish students, a follow-up was carried out after 6 months. Depending on the distributions, t tests or Mann-Whitney tests were used. Correlation between variables was assessed by using Spearman rank correlation. Regression analyses were used for time-dependent variables. The participants enjoyed the training and reported a self-perceived benefit as a consequence of training. The mean rating for self-efficacy increased from 5.8/7 (SD 0.72) to 6.5/7 (SD 0.57, Ponline MMVWs

  19. Introduction to the special issue from the proceedings of the 2006 International Workshop on Virtual Reality in Rehabilitation

    Directory of Open Access Journals (Sweden)

    Keshner Emily A

    2007-06-01

    Full Text Available Abstract New technologies are rapidly having a great impact on the development of novel rehabilitation interventions. One of the more popular of these technological advances is virtual reality. The wide range of applications of this technology, from immersive environments to tele-rehabilitation equipment and care, lends versatility to its use as a rehabilitation intervention. But increasing access to this technology requires that we further our understanding about its impact on a performer. The International Workshop on Virtual Reality in Rehabilitation (IWVR, now known as Virtual Rehabilitation 2007, is a conference that emerged from the need to discover how virtual reality could be applied to rehabilitation practice. Individuals from multiple disciplines concerned with the development, transmission, and evaluation of virtual reality as a technology applied to rehabilitation attend this meeting to share their work. In this special issue of the Journal of NeuroEngineering and Rehabilitation we are sharing some of the papers presented at the 2006 meeting of IWVR with the objective of offering a description of the state of the art in this research field. A perusal of these papers will provide a good cross-section of the emerging work in this area as well as inform the reader about new findings relevant to research and practice in rehabilitation.

  20. Social Media Providing an International Virtual Elective Experience for Student Nurses

    Directory of Open Access Journals (Sweden)

    Paula M. Procter

    2017-04-01

    Full Text Available The advances in social media offer many opportunities for developing understanding of different countries and cultures without any implications of travel. Nursing has a global presence and yet it appears as though students have little knowledge of the health and social care needs and provision outside their local environment. Our collaboration across three countries, New Zealand, United Kingdom, and the United States of America, brought the two themes together with the aim of senior student nurses having a communication channel to explore public health issues in each country. Using a closed Facebook™ page, third year undergraduate adult nursing students were invited to take part in a three month pilot study to test the feasibility of virtual collaboration through exchanging public health issues. Here we report upon the collaboration, operation of the social media, and main findings of the study. Three core areas will be reported upon, these being the student’s views of using social media for learning about international perspectives of health, seeing nursing as a global profession and recommendations for future development of this positively reviewed learning technique. To conclude consideration will be given to further development of this work by the collaborative team expanding the countries involved.

  1. Problem-based learning in internal medicine: virtual patients or paper-based problems?

    Science.gov (United States)

    Sobocan, Monika; Turk, Neja; Dinevski, Dejan; Hojs, Radovan; Pecovnik Balon, Breda

    2017-01-01

    Teaching using paper problem-based learning (p-PBL) sessions has left some students fatigued with the learning process. Therefore, attempts have been made to replace p-PBL with digitally enhanced, decision-making PBL in the form of virtual patients (VP). Student enthusiasm for substituting p-PBL with VP has not been quantitatively evaluated on the intended educational effects. To determine the educational effects of substituting p-PBL sessions with VP on undergraduate medical students in their internal medicine course. We conducted a randomised controlled study on 34 third-year undergraduate medical students in the academic year 2015-2016. Student performance after an intervention substituting p-PBL sessions with VP was analysed. The educational outcomes were measured with knowledge exams and the Diagnostic Thinking Inventory. There was no difference in exam performance between groups (P > 0.833) immediately after the intervention, or in long term. Nor was there a significant difference in improvement of diagnostic thinking between groups (P > 0.935 and P > 0.320). Our study showed no significant improvement in diagnostic thinking abilities or knowledge exam results with the use of VP. Educators can add VP to sessions to motivate students, but a significant improvement to educational outcome should not be expected. © 2016 Royal Australasian College of Physicians.

  2. The international forum of ophthalmic simulation: developing a virtual reality training curriculum for ophthalmology.

    Science.gov (United States)

    Saleh, George M; Lamparter, Julia; Sullivan, Paul M; O'Sullivan, Fiona; Hussain, Badrul; Athanasiadis, Ioannis; Litwin, Andre S; Gillan, Stewart N

    2013-06-01

    To investigate the effect of a structured, supervised, cataract simulation programme on ophthalmic surgeons in their first year of training, and to evaluate the level of skill transfer. Trainees with minimal intraocular and simulator experience in their first year of ophthalmology undertook a structured, sequential, customised, virtual reality (VR) cataract training programme developed through the International Forum of Ophthalmic Simulation. A set of one-handed, bimanual, static and dynamic tasks were evaluated before and after the course and scores obtained. Statistical significance was evaluated with the Wilcoxon sign-rank test. The median precourse score of 101.50/400 (IQR 58.75-145.75) was significantly improved after completing the training programme ((postcourse score: 302/400, range: 266.25-343), p<0.001). While improvement was evident and found to be statistically significant in all parameters, greatest improvements were found for capsulorhexis and antitremor training ((Capsulorhexis: precourse score=0/100, range 0-4.5; postcourse score=81/100, range 13-87.75; p=0.002), (antitremor training: precourse score=0/100, range 0-0; postcourse score=80/100, range 60.25-91.50; p=0.001)). Structured and supervised VR training can offer a significant level of skills transfer to novice ophthalmic surgeons. VR training at the earliest stage of ophthalmic surgical training may, therefore, be of benefit.

  3. Simulation of water flow in fractured porous medium by using discretized virtual internal bond

    Science.gov (United States)

    Peng, Shujun; Zhang, Zhennan; Li, Chunfang; He, Guofu; Miao, Guoqing

    2017-12-01

    The discretized virtual internal bond (DVIB) is adopted to simulate the water flow in fractured porous medium. The intact porous medium is permeable because it contains numerous micro cracks and pores. These micro discontinuities construct a fluid channel network. The representative volume of this fluid channel network is modeled as a lattice bond cell with finite number of bonds in statistical sense. Each bond serves as a fluid channel. In fractured porous medium, many bond cells are cut by macro fractures. The conductivity of the fracture facet in a bond cell is taken over by the bonds parallel to the flow direction. The equivalent permeability and volumetric storage coefficient of a micro bond are calibrated based on the ideal bond cell conception, which makes it unnecessary to consider the detailed geometry of a specific element. Such parameter calibration method is flexible and applicable to any type of element. The accuracy check results suggest this method has a satisfying accuracy in both the steady and transient flow simulation. To simulate the massive fractures in rockmass, the bond cells intersected by fracture are assigned aperture values, which are assumed random numbers following a certain distribution law. By this method, any number of fractures can be implicitly incorporated into the background mesh, avoiding the setup of fracture element and mesh modification. The fracture aperture heterogeneity is well represented by this means. The simulation examples suggest that the present method is a feasible, simple and efficient approach to the numerical simulation of water flow in fractured porous medium.

  4. Experimental Evaluation of a Method for Turbocharging Four-Stroke, Single Cylinder, Internal Combustion Engines

    Science.gov (United States)

    Buchman, Michael; Winter, Amos

    2015-11-01

    Turbocharging an engine increases specific power, improves fuel economy, reduces emissions, and lowers cost compared to a naturally aspirated engine of the same power output. These advantages make turbocharging commonplace for multi-cylinder engines. Single cylinder engineers are not commonly turbocharged due to the phase lag between the exhaust stroke, which powers the turbocharger, and the intake stroke, when air is pumped into the engine. Our proposed method of turbocharging single cylinder engines is to add an ``air capacitor'' to the intake manifold, an additional volume that acts as a buffer to store compressed air between the exhaust and intake strokes, and smooth out the pressure pulses from the turbocharger. This talk presents experimental results from a single cylinder, turbocharged diesel engine fit with various sized air capacitors. Power output from the engine was measured using a dynamometer made from a generator, with the electrical power dissipated with resistive heating elements. We found that intake air density increases with capacitor size as theoretically predicted, ranging from 40 to 60 percent depending on heat transfer. Our experiment was able to produce 29 percent more power compared to using natural aspiration. These results validated that an air capacitor and turbocharger may be a simple, cost effective means of increasing the power density of single cylinder engines.

  5. Stroke rehabilitation.

    Science.gov (United States)

    Langhorne, Peter; Bernhardt, Julie; Kwakkel, Gert

    2011-05-14

    Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially beneficial treatment options for motor recovery of the arm include constraint-induced movement therapy and robotics. Promising interventions that could be beneficial to improve aspects of gait include fitness training, high-intensity therapy, and repetitive-task training. Repetitive-task training might also improve transfer functions. Occupational therapy can improve activities of daily living; however, information about the clinical effect of various strategies of cognitive rehabilitation and strategies for aphasia and dysarthria is scarce. Several large trials of rehabilitation practice and of novel therapies (eg, stem-cell therapy, repetitive transcranial magnetic stimulation, virtual reality, robotic therapies, and drug augmentation) are underway to inform future practice. Copyright © 2011 Elsevier Ltd. All rights reserved.

  6. Networking support for collaborative virtual reality projects in national, european and international context

    OpenAIRE

    Hommes, F.; Pless, E.

    2004-01-01

    The report describes experiences from networking support for two three years virtual reality projects. Networking requirements depending on the virtual reality environment and the planned distributed scenarios are specified and verified in the real network. Networking problems especially due to the collaborative, distributed character of interaction via the Internet are presented.

  7. Haptic/graphic rehabilitation: integrating a robot into a virtual environment library and applying it to stroke therapy.

    Science.gov (United States)

    Sharp, Ian; Patton, James; Listenberger, Molly; Case, Emily

    2011-08-08

    Recent research that tests interactive devices for prolonged therapy practice has revealed new prospects for robotics combined with graphical and other forms of biofeedback. Previous human-robot interactive systems have required different software commands to be implemented for each robot leading to unnecessary developmental overhead time each time a new system becomes available. For example, when a haptic/graphic virtual reality environment has been coded for one specific robot to provide haptic feedback, that specific robot would not be able to be traded for another robot without recoding the program. However, recent efforts in the open source community have proposed a wrapper class approach that can elicit nearly identical responses regardless of the robot used. The result can lead researchers across the globe to perform similar experiments using shared code. Therefore modular "switching out"of one robot for another would not affect development time. In this paper, we outline the successful creation and implementation of a wrapper class for one robot into the open-source H3DAPI, which integrates the software commands most commonly used by all robots.

  8. Use of a virtual world computer environment for international distance education: lessons from a pilot project using Second Life.

    Science.gov (United States)

    Schoonheim, Marloes; Heyden, Robin; Wiecha, John M

    2014-02-21

    Virtual worlds (VWs), in which participants navigate as avatars through three-dimensional, computer-generated, realistic-looking environments, are emerging as important new technologies for distance health education. However, there is relatively little documented experience using VWs for international healthcare training. The Geneva Foundation for Medical Education and Research (GFMER) conducted a VW training for healthcare professionals enrolled in a GFMER training course. This paper describes the development, delivery, and results of a pilot project undertaken to explore the potential of VWs as an environment for distance healthcare education for an international audience that has generally limited access to conventionally delivered education.

  9. Burden of stroke in Bangladesh.

    Science.gov (United States)

    Islam, Md Nazmul; Moniruzzaman, Mohammed; Khalil, Md Ibrahim; Basri, Rehana; Alam, Mohammad Khursheed; Loo, Keat Wei; Gan, Siew Hua

    2013-04-01

    Stroke is the third leading cause of death in Bangladesh. The World Health Organization ranks Bangladesh's mortality rate due to stroke as number 84 in the world. The reported prevalence of stroke in Bangladesh is 0.3%, although no data on stroke incidence have been recorded. Hospital-based studies conducted in past decades have indicated that hypertension is the main cause of ischaemic and haemorrhagic stroke in Bangladesh. The high number of disability-adjusted life-years lost due to stroke (485 per 10,000 people) show that stroke severely impacts Bangladesh's economy. Although two non-governmental organizations, BRAC and the Centre for the Rehabilitation of the Paralysed, are actively involved in primary stroke prevention strategies, the Bangladeshi government needs to emphasize healthcare development to cope with the increasing population density and to reduce stroke occurrence. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

  10. A template-based procedure for determining white matter integrity in the internal capsule early after stroke

    Directory of Open Access Journals (Sweden)

    Matthew A. Petoe

    2014-01-01

    Full Text Available The integrity of descending white matter pathways, measured by fractional anisotropy from DW-MRI, is a key prognostic indicator of motor recovery after stroke. Barriers to translation of fractional anisotropy measures into routine clinical practice include the time required for manually delineating volumes of interest (VOIs, and inter-examiner variability in this process. This study investigated whether registering and then editing template volumes of interest ‘as required’ would improve inter-examiner reliability compared with manual delineation, without compromising validity. MRI was performed with 30 sub-acute stroke patients with motor deficits (mean NIHSS = 11, range 0–17. Four independent examiners manually delineated VOIs for the posterior limbs of the internal capsules on T1 images, or edited template VOIs that had been registered to the T1 images if they encroached on ventricles or basal ganglia. Fractional anisotropy within each VOI and interhemispheric asymmetry were then calculated. We found that 13/30 registered template VOIs required editing. Edited template VOIs were more spatially similar between examiners than the manually delineated VOIs (p = 0.005. Both methods produced similar asymmetry values that correlated with clinical scores with near perfect levels of agreement between examiners. Contralesional fractional anisotropy correlated with age when edited template VOIs were used but not when VOIs were manually delineated. Editing template VOIs as required is reliable, increases the validity of fractional anisotropy measurements in the posterior limb of the internal capsule, and is less time-consuming compared to manual delineation. This approach could support the use of FA asymmetry measures in routine clinical practice.

  11. Brainstem ischemic stroke without permanent sequelae during the course of spontaneous internal carotid artery dissection – case report

    International Nuclear Information System (INIS)

    Nesteruk, Tomasz; Nesteruk, Marta; Bulik-Pasińska, Marta; Boroszko, Dariusz; Ostrowska, Monika

    2012-01-01

    Internal carotid artery dissection (ICAD) is a frequent cause of a stroke in young patients. Risk factors which can lead to dissection include neck injury and diseases of the inner wall of the artery. Common symptoms in ICAD are cervical pain and headache, Horner’s syndrome, paralysis of the cranial nerves and subsequently cerebral and retinal ischemia. MR angiography in TOF technique and brain MRI in T1- and T2-weighted images, FLAIR and DWI sequences are the method of choice in patients with ICAD but contrast-enhanced multislice computed tomography remains the fastest and the most available diagnostic method. A 39-year old woman, previously healthy, presented to the Hospital Emergency Department because of increasing neck pain on the right side and difficulty in swallowing. The neurological examination revealed: drooping of the right eyelid with narrow palpebral fissure, dysarthria, anisocoria (narrower pupil on the right side), unilateral hypoesthesia on the left side, weak palatal and pharyngeal reflexes on both sides, paresthesia within the left half of the body. Seven days before, the patient felt a sudden, severe neck pain radiating to the temporal apophysis. CT angiography revealed a defect in contrast filling within the left internal carotid artery and right vertebral artery. MRI of the head with MR angiography showed internal carotid artery dissection on the left side and dissection of the right vertebral artery and no ischemic changes within the brain. CT and MR angiography are methods characterized by high sensitivity in detecting dissection of the cervical arteries

  12. Ischemic stroke in combined cerebrovascular abnormalities - aneurysm of the right internal carotid artery and arteriovenous malformation temporo occipital in the right hemisphere

    International Nuclear Information System (INIS)

    Manolova, T.; Naydenov, K.; Manchev, I.; Manchev, L.

    2016-01-01

    A case of combined vascular abnormalities is presented- an aneurysm of the internal carotid artery and arterio-venous malformation temporooccipitally on the right, clinically presented by an ischemic brain stroke in the territory supplied by the right middle cerebral artery. Treatment included - hypo-tensive drugs, antiplatelet (antiaggregants) agents and vasodilators, which lead to significant improvement of the general and focal neurological symptoms. Neurosurgical intervention is been discussed, in order to remove the vascular malformation and to prevent future vascular events. Key words: Aneurysm. Arteriovenous Malformation. Ischemic Stroke

  13. Does the addition of virtual reality training to a standard program of inpatient rehabilitation improve sitting balance ability and function after stroke? Protocol for a single-blind randomized controlled trial.

    Science.gov (United States)

    Sheehy, L; Taillon-Hobson, A; Sveistrup, H; Bilodeau, M; Fergusson, D; Levac, D; Finestone, H

    2016-03-31

    Sitting ability and function are commonly impaired after stroke. Balance training has been shown to be helpful, but abundant repetitions are required for optimal recovery and patients must be motivated to perform rehabilitation exercises repeatedly to maximize treatment intensity. Virtual reality training (VRT), which allows patients to interact with a virtual environment using computer software and hardware, is enjoyable and may encourage greater repetition of therapeutic exercises. However, the potential for VRT to promote sitting balance has not yet been explored. The objective of this study is to determine if supplemental VRT-based sitting balance exercises improve sitting balance ability and function in stroke rehabilitation inpatients. This is a single-site, single-blind, parallel-group randomized control trial. Seventy six stroke rehabilitation inpatients who cannot stand independently for greater than one minute but can sit for at least 20 minutes (including at least one minute without support) are being recruited from a tertiary-care dedicated stroke rehabilitation unit. Participants are randomly allocated to experimental or control groups. Both participate in 10-12 sessions of 30-45 minutes of VRT performed in sitting administered by a single physiotherapist, in addition to their traditional therapy. The experimental group plays five games which challenge sitting balance while the control group plays five games which minimize trunk lean. Outcome measures of sitting balance ability (Function in Sitting Test, Ottawa Sitting Scale, quantitative measures of postural sway) and function (Reaching Performance Scale, Wolf Motor Function Test, quantitative measures of the limits of stability) are administered prior to, immediately following, and one month following the intervention by a second physiotherapist blind to the participant's group allocation. The treatment of sitting balance post-stroke with VRT has not yet been explored. Results from the current study

  14. Stroke Treatments

    Science.gov (United States)

    ... Stroke Association.org Professionals for Stroke Association.org Shop for Stroke Association.org Support for Stroke Association. ... works by dissolving the clot and improving blood flow to the part of the brain being deprived ...

  15. Methodological issues for designing and conducting a multicenter, international clinical trial in Acute Stroke: Experience from ARTSS-2 trial.

    Science.gov (United States)

    Rahbar, Mohammad H; Dickerson, Aisha S; Cai, Chunyan; Pedroza, Claudia; Hessabi, Manouchehr; Shen, Loren; Pandurengan, Renganayaki; Jacobs, Amber Nicole M; Indupuru, Hari; Sline, Melvin R; Delgado, Rigoberto I; Macdonald, Claire; Ford, Gary A; Grotta, James C; Barreto, Andrew D

    2015-09-01

    We describe innovations in the study design and the efficient data coordination of a randomized multicenter trial of Argatroban in Combination with Recombinant Tissue Plasminogen Activator for Acute Stroke (ARTSS-2). ARTSS-2 is a 3-arm, multisite/multiregional randomized controlled trials (RCTs) of two doses of Argatroban injection (low, high) in combination with recombinant tissue plasminogen activator (rt-PA) in acute ischemic stroke patients and rt-PA alone. We developed a covariate adaptive randomization program that balanced the study arms with respect to study site as well as hemorrhage after thrombolysis (HAT) score and presence of distal internal carotid artery occlusion (DICAO). We used simulation studies to validate performance of the randomization program before making any adaptations during the trial. For the first 90 patients enrolled in ARTSS-2, we evaluated performance of our randomization program using chi-square tests of homogeneity or extended Fisher's exact test. We also designed a four-step partly Bayesian safety stopping rule for low and high dose Argatroban arms. Homogeneity of the study arms was confirmed with respect to distribution of study site (UK sites vs. US sites, P=0.98), HAT score (0-2 vs. 3-5, P=1.0), and DICAO (N/A vs. No vs. Yes, P=0.97). Our stopping thresholds for safety of low and high dose Argatroban were not crossed. Despite challenges, data quality was assured. We recommend adaptive designs for randomization and Bayesian safety stopping rules for multisite Phase I/II RCTs for maintaining additional flexibility. Efficient data coordination could lead to improved data quality. Copyright © 2015. Published by Elsevier Inc.

  16. Assessment of laparoscopic psychomotor skills in interns using the MIST Virtual Reality Simulator: a prerequisite for those considering surgical training?

    Science.gov (United States)

    Cope, Daron H; Fenton-Lee, Douglas

    2008-04-01

    Selection for surgical training in Australia is currently based on assessment of a structured curriculum vitae, referral reports from selected clinicians and an interview. The formal assessment of laparoscopic psychomotor skill and ability to attain skills is not currently a prerequisite for selection. The aim of this study was to assess the innate psychomotor skills of interns and also to compare interns with an interest in pursuing a surgical career to interns with those with no interest in pursuing a surgical career. Twenty-two interns were given the opportunity to carry out tasks on the Minimal Invasive Surgical Trainer, Virtual Reality (Mentice, Gothenburg, Sweden) Simulator. The candidates were required to complete six tasks, repeated six times each. Scores for each task were calculated objectively by the simulator software. Demographic data were similar between the two groups. Although some candidates who were interested in pursuing a surgical career performed poorly on the simulator, there was no significant difference when comparing the two groups. The Minimal Invasive Surgical Trainer, Virtual Reality (Mentice) Simulator provides an objective and comparable assessment of laparoscopic psychomotor skills. We can conclude that interns have varying inherent ability as judged by the simulator and this does not seem to have an influence on their career selection. There was no significant difference in the scores between the two groups. Interns with and without inherent abilities have aspirations to pursue surgical careers and their aptitude does not seem to influence this decision. Surgical colleges could use psychomotor ability assessments to recruit candidates to pursue a career in surgery. Trainees needing closer monitoring and additional training could be identified early and guided to achieve competency.

  17. Multiple Strokes

    Directory of Open Access Journals (Sweden)

    Obododimma Oha

    2008-12-01

    Full Text Available This poem playfully addresses the slippery nature of linguistic signification, employing humour and sarcasm in presenting a wide range of human experience. It ironical twists -- and "strokes" (read ambiguously as both a giving a punishment and erotic pleasuring -- move from the naming of location through international discourse of capital to the crumbling relationships between nation states. It reading of the signs of language is tied to the unease and fracture in cultural and political experience.

  18. SEMINAR ABOUT SERIOUS GAMES AND VIRTUAL WORLDS: An Experience of International Collaboration And Reflection

    Directory of Open Access Journals (Sweden)

    Wolfram LAASER

    2011-08-01

    Full Text Available The educational possibilities of ICT, dizzying and exponentially growing every day, offer multiple alternatives of mediation for teaching, learning and communication.Thus, the inclusion of video games and virtual worlds into educational context represents a qualitative leap that claims to significantly boost ways of communication and knowledge representation of the scenarios involved. Aware of this reality, in the framework of the Master of Technology Enhanced Learning at the National University of Cordoba, Argentina, a virtual seminar was offered to students to address the issue on the basis of invited lectures of worldwide recognized experts. The format chosen for the seminar allowed the treatment of subjects not only through reading assignments and web quests to be discussed collaboratively but also included the state of the art experience of developers working in the field. The paper describes didactic design and technical solutions of the seminar format.

  19. The virtual library in action: Collaborative international control of high-energy physics pre-print

    International Nuclear Information System (INIS)

    Kreitz, P.A.; Addis, L.; Galic, H.; Johnson, T.

    1996-02-01

    This paper will discuss how control of the grey literature in high-energy physics pre-prints developed through a collaborative effort of librarians and physicists. It will highlight the critical steps in the development process and describe one model of a rapidly evolving virtual library for high-energy physics information. In conclusion, this paper will extend this physics model to other areas of grey literature management

  20. The anticoagulation choices of internal medicine residents for stroke prevention in non-valvular atrial fibrillation.

    Science.gov (United States)

    Moulson, Nathaniel; McIntyre, William F; Oqab, Zardasht; Yazdan-Ashoori, Payam; Quinn, Kieran L; van Oosten, Erik; Hopman, Wilma M; Baranchuk, Adrian

    2017-06-01

    To explore the oral anticoagulation (OAC) prescribing choices of Canadian internal medicine residents, at different training levels, in comparison with the Canadian Cardiovascular Society (CCS) guidelines for non-valvular atrial fibrillation (NVAF). Cross-sectional, web-based survey, involving clinical scenarios designed to favour the use of non-vitamin K antagonists (NOACs) as per the 2014 CCS NVAF guidelines. Additional questions were also designed to determine resident attitudes towards OAC prescribing. A total of 518 internal medicine responses were analysed, with 196 postgraduate year (PGY)-1s, 169 PGY-2s and 153 PGY-3s. The majority of residents (81%) reported feeling comfortable choosing OAC, with 95% having started OAC in the past 3 months. In the initial clinical scenario involving an uncomplicated patient with a CHADS2 score of 3, warfarin was favoured over any of the NOACs by PGY-1s (81.6% vs 73.9%), but NOACs were favoured by PGY-3s (88.3% vs 83.7%). This was the only scenario where OAC choices varied by PGY year, as each of the subsequent clinical scenarios residents generally favoured warfarin over NOACs irrespective of level of training. The majority of residents stated that they would no longer prescribe warfarin once NOAC reversal agents are available, and residents felt risk of adverse events was the most important factor when choosing OAC. Canadian internal medicine residents favoured warfarin over NOACs for patients with NVAF, which is in discordance with the evidence-based CCS guidelines. This finding persisted throughout the 3 years of core internal medicine training. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  1. Disentangling interoception: insights from focal strokes affecting the perception of external and internal milieus

    Science.gov (United States)

    Couto, Blas; Adolfi, Federico; Sedeño, Lucas; Salles, Alejo; Canales-Johnson, Andrés; Alvarez-Abut, Pablo; Garcia-Cordero, Indira; Pietto, Marcos; Bekinschtein, Tristan; Sigman, Mariano; Manes, Facundo; Ibanez, Agustin

    2015-01-01

    Interoception is the moment-to-moment sensing of the physiological condition of the body. The multimodal sources of interoception can be classified into two different streams of afferents: an internal pathway of signals arising from core structures (i.e., heart, blood vessels, and bronchi) and an external pathway of body-mapped sensations (i.e., chemosensation and pain) arising from peripersonal space. This study examines differential processing along these streams within the insular cortex (IC) and their subcortical tracts connecting frontotemporal networks. Two rare patients presenting focal lesions of the IC (insular lesion, IL) or its subcortical tracts (subcortical lesion, SL) were tested. Internally generated interoceptive streams were assessed through a heartbeat detection (HBD) task, while those externally triggered were tapped via taste, smell, and pain recognition tasks. A differential pattern was observed. The IC patient showed impaired internal signal processing while the SL patient exhibited external perception deficits. Such selective deficits remained even when comparing each patient with a group of healthy controls and a group of brain-damaged patients. These outcomes suggest the existence of distinguishable interoceptive streams. Results are discussed in relation with neuroanatomical substrates, involving a fronto-insulo-temporal network for interoceptive and cognitive contextual integration. PMID:25983697

  2. ISMCR 1994: Topical Workshop on Virtual Reality. Proceedings of the Fourth International Symposium on Measurement and Control in Robotics

    Science.gov (United States)

    1994-01-01

    This symposium on measurement and control in robotics included sessions on: (1) rendering, including tactile perception and applied virtual reality; (2) applications in simulated medical procedures and telerobotics; (3) tracking sensors in a virtual environment; (4) displays for virtual reality applications; (5) sensory feedback including a virtual environment application with partial gravity simulation; and (6) applications in education, entertainment, technical writing, and animation.

  3. Internal fixation versus conservative treatment for elderly patients with a trochanteric hip fracture in conjunction with post-stroke hemiplegia.

    Science.gov (United States)

    Li, Kainan; Zheng, Yingjie

    2016-10-01

    To retrospectively evaluated Gamma nail internal fixation in the treatment of elderly patients with post-stroke hemiplegia experiencing trochanteric hip fracture. The patients were obtained consecutively from January 2005 to December 2010 with inclusion criteria. The total number was 138 and allocated to two groups: treated with the Gamma nail (n=72,group A) and continuous skin traction (n=66,group B). Preoperative variables including patient age, gender, duration of cerebrovascular accident, duration of hypertension, ASA risk score, Harris hip score and fracture type were recorded and compared. After treatment, time of patients activity on the bed, ambulation time, Harris hip score, mortality, complications were recorded and used to compare the outcomes. (1) Follow-up was undertaken from 3 to 10 years, with an average of 5.8 years. (2) No statistical difference in preoperative variables was found between the 2 groups. (3) two groups had statistical significance (P=0.000) in the time of patients activity on the bed and ambulation time and group A can activities on the bed and ambulates earlier. (4) There were significant differences between 2 groups in Harris hip score at 1 and 3 years and group A was significantly higher than group B. (5) there were statistically significant differences in mortality of 3 years, 5 years and 10 years and the group B was significantly higher than the group A. (6) There was a statistical significance in complications between 2 groups and group B was higher than group A. Major complications in group A were pain, lag screw cut out, implant infection and distal femoral fractures caused by fall after the surgery. On elderly patients with trochanteric hip fracture on the hemiplegic lower side, Gamma nail internal fixation treatment can achieve better effect, patients can be early activity, fewer complications, and less mortality. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Clinical assessment of fear of falling after stroke: validity, reliability and responsiveness of the Persian version of the Fall Efficacy Scale-International.

    Science.gov (United States)

    Azad, Akram; Hassani Mehraban, Afsoon; Mehrpour, Masoud; Mohammadi, Babak

    2014-01-01

    Fear of falling may be related to falling during stroke onset. The Fall Efficacy ScaleInternational (FES-I) with excellent psychometric properties, is an instrument developed to assess patients' concerns about fallings. The aim of this study was to determine validation of this scale in Iranian patients with stroke. The "forward-backward" procedure was applied to translate the FES-I from English to Persian. One hundred-twenty patients who had suffered stroke, aged 40 to 80 years (55% male) completed the Persian FES-I, Geriatric Depression Scale-15 (GDS-15), General Health Questionnaire-28 (GHQ-28), Berg Balance Scale (BBS) and Timed up and Go (TUG) questionnaires. The interval time for the test-retest of the Persian scale was 7-14 days. The test-retest and inter-rater reliabilities of the Persian FES-I were excellent (ICC2,1=0.98, pPersian scale showed only one significant factor. The total Persian FES-I score had a significantly negative correlation (pPersian FES-I proved to be an effective and valuable measurement tool to assess stroke patients' fear of falling in practice and research setting.

  5. Stroke in Commercial Flights.

    Science.gov (United States)

    Álvarez-Velasco, Rodrigo; Masjuan, Jaime; DeFelipe, Alicia; Corral, Iñigo; Estévez-Fraga, Carlos; Crespo, Leticia; Alonso-Cánovas, Araceli

    2016-04-01

    Stroke on board aircraft has been reported in retrospective case series, mainly focusing on economy class stroke syndrome. Data on the actual incidence, pathogenesis, and prognosis of stroke in commercial flights are lacking. A prospective registry was designed to include all consecutive patients referred from an international airport (40 million passengers a year) to our hospital with a diagnosis of ischemic stroke or transient ischemic attack and onset of symptoms during a flight or immediately after landing. Forty-four patients (32 ischemic strokes and 12 transient ischemic attacks) were included over a 76-month period (January 2008 to April 2014). The estimated incidence of stroke was 1 stroke in 35 000 flights. Pathogeneses of stroke or transient ischemic attack were atherothrombotic in 16 (36%), economy class stroke syndrome in 8 (18%), cardioembolic in 7 (16%), arterial dissection in 4 (9%), lacunar stroke in 4 (9%), and undetermined in 5 (12%) patients. Carotid stenosis >70% was found in 12 (27%) of the patients. Overall prognosis was good, and thrombolysis was applied in 44% of the cases. The most common reason for not treating patients who had experienced stroke onset midflight was the delay in reaching the hospital. Only 1 patient with symptom onset during the flight prompted a flight diversion. We found a low incidence of stroke in the setting of air travel. Economy class stroke syndrome and arterial dissection were well represented in our sample. However, the main pathogenesis was atherothrombosis with a high proportion of patients with high carotid stenosis. © 2016 American Heart Association, Inc.

  6. Experimental investigation of the influence of internal and external EGR on the combustion characteristics of a controlled auto-ignition two-stroke cycle engine

    International Nuclear Information System (INIS)

    Andwari, Amin Mahmoudzadeh; Aziz, Azhar Abdul; Said, Mohd Farid Muhamad; Latiff, Zulkarnain Abdul

    2014-01-01

    Highlights: • Investigate the effect of In-EGR, Ex-EGR and octane number on a CAI 2-stroke engine. • Effect of In-EGR, Ex-EGR and octane number on combustion phasing of the engine. • Effect of In-EGR, Ex-EGR and octane number on cyclic variability of the engine. • Identify the CAI combustion upper and lower boundary for operating regions. - Abstract: A two-stroke cycle engine incorporated with a controlled auto-ignition combustion approach presents a high thermodynamic efficiency, ultra-low exhaust emissions and high power-to-weight ratio features for future demand of prime movers. The start of auto-ignition, control of the auto-ignition and its cyclic variability, are major concerns that should be addressed in the combustion timing control of controlled auto-ignition engines. Several studies have been performed to examine the effect of internal exhaust gas recirculation utilization on auto-ignited two-stroke cycle engines. However, far too little attention has been devoted to study on the influence of external exhaust gas recirculation on the cyclic variation and the combustion characteristics of controlled auto-ignition two-stroke cycle engines. The purpose of this study is to examine the influence of external exhaust gas recirculation in combination with internal exhaust gas recirculation on the combustion characteristics and the cyclic variability of a controlled auto-ignition two-stroke engine using fuel with different octane numbers. In a detailed experimental investigation, the combustion-related and pressure-related parameters of the engine are examined and statistically associated with the coefficient of variation and the standard deviation. The outcomes of the investigation indicates that the most influential controlled auto-ignition combustion phasing parameters can be managed appropriately via regulating the internal and external exhaust gas recirculation and fuel octane number. In general, start of auto-ignition and its cyclic variability are

  7. Terapia baseada em realidade virtual usando o leap motion controller para reabilitação do membro superior após acidente vascular cerebral = Virtual reality therapy using the leap motion controller for post-stroke upper limb rehabilitation Virtual reality therapy using the Leap Motion Controller for post-stroke upper limb rehabilitation

    Directory of Open Access Journals (Sweden)

    Soares, Nayron Medeiros

    2017-01-01

    Full Text Available OBJETIVOS: Avaliar a aplicabilidade de um sensor de movimento, baseado em realidade virtual, para promover a reabilitação do membro superior após um acidente vascular cerebral. RELATO DOS CASOS: Três pacientes após acidente vascular cerebral realizaram um treino para reabilitação do membro superior com realidade virtual usando a tecnologia Leap Motion Controller e o jogo Playground 3D®, durante três dias consecutivos. No primeiro e no terceiro dia, foram avaliados com os testes Caixa e Blocos, Coordenação Óculo-Manual de Melo e Estimulação Magnética Transcraniana. No último dia, foram aplicadas Fichas de Avaliação da Experiência do paciente. Após o treinamento proposto, observou-se diminuição do limiar motor em ambos os hemisférios cerebrais e melhores desempenhos nos testes que avaliaram a habilidade manual e óculo-manual. A terapia proposta foi bem recebida pelos pacientes testados. CONCLUSÕES: Não foram observados efeitos adversos e os resultados mostram-se promissores e precisos no treinamento realizado com realidade virtual usando a tecnologia Leap Motion Controller e o jogo Playground 3D®. O treinamento proporcionou uma participação ativa dos pacientes na reabilitação das sequelas de extremidade superior após um acidente vascular cerebral

  8. iSERVO: Implementing the International Solid Earth Research Virtual Observatory by Integrating Computational Grid and Geographical Information Web Services

    Science.gov (United States)

    Aktas, Mehmet; Aydin, Galip; Donnellan, Andrea; Fox, Geoffrey; Granat, Robert; Grant, Lisa; Lyzenga, Greg; McLeod, Dennis; Pallickara, Shrideep; Parker, Jay; Pierce, Marlon; Rundle, John; Sayar, Ahmet; Tullis, Terry

    2006-12-01

    We describe the goals and initial implementation of the International Solid Earth Virtual Observatory (iSERVO). This system is built using a Web Services approach to Grid computing infrastructure and is accessed via a component-based Web portal user interface. We describe our implementations of services used by this system, including Geographical Information System (GIS)-based data grid services for accessing remote data repositories and job management services for controlling multiple execution steps. iSERVO is an example of a larger trend to build globally scalable scientific computing infrastructures using the Service Oriented Architecture approach. Adoption of this approach raises a number of research challenges in millisecond-latency message systems suitable for internet-enabled scientific applications. We review our research in these areas.

  9. The Virtual International Day of the Midwife: A Synchronous Open Online Conference for Continuing Professional Development and Learning for Midwives

    DEFF Research Database (Denmark)

    Sidebotham, Mary; Dalsgaard, Annette; Davis, Deborah

    2015-01-01

    AIM: To examine the contribution of the Virtual International Day of the Midwife (VIDM) conference to midwives' continuing professional development (CPD). BACKGROUND: Knowledge and understanding of CPD for midwives as synchronous online learning is limited. Studies of e-learning programs for CPD...... to participants for 1 month after the conference via the wiki page in 2012 and 2013. FINDINGS: The survey was completed by 239 conference participants. Midwifery students and clinical midwives were the largest groups of attendees. The most common countries of residence were Australia, United Kingdom, and United...... States. Respondents believed that the conference contributed to their professional development by enabling professional growth, facilitating shared learning, and raising awareness of global issues. CONCLUSION: Offering synchronous events is important to facilitate deeper learning for those engaging...

  10. Enabling Manufacturing Competitiveness and Economic Sustainability : Proceedings of the 4th International Conference on Changeable, Agile, Reconfigurable and Virtual production

    CERN Document Server

    2012-01-01

    The changing manufacturing environment requires more responsive and adaptable manufacturing systems. The theme of the 4th International Conference on Changeable, Agile, Reconfigurable and Virtual production (CARV2011) is “Enabling Manufacturing Competitiveness and Economic Sustainability”. Leading edge research and best implementation practices and experiences, which address these important issues and challenges, are presented. The proceedings include advances in manufacturing systems design, planning, evaluation, control and evolving paradigms such as mass customization, personalization, changeability, re-configurability and flexibility. New and important concepts such as the dynamic product families and platforms, co-evolution of products and systems, and methods for enhancing manufacturing systems’ economic sustainability and prolonging their life to produce more than one product generation are treated. Enablers of change in manufacturing systems, production volume and capability scalability and man...

  11. A highly efficient six-stroke internal combustion engine cycle with water injection for in-cylinder exhaust heat recovery

    International Nuclear Information System (INIS)

    Conklin, James C.; Szybist, James P.

    2010-01-01

    A concept adding two strokes to the Otto or Diesel engine cycle to increase fuel efficiency is presented here. It can be thought of as a four-stroke Otto or Diesel cycle followed by a two-stroke heat recovery steam cycle. A partial exhaust event coupled with water injection adds an additional power stroke. Waste heat from two sources is effectively converted into usable work: engine coolant and exhaust gas. An ideal thermodynamics model of the exhaust gas compression, water injection and expansion was used to investigate this modification. By changing the exhaust valve closing timing during the exhaust stroke, the optimum amount of exhaust can be recompressed, maximizing the net mean effective pressure of the steam expansion stroke (MEP steam ). The valve closing timing for maximum MEP steam is limited by either 1 bar or the dew point temperature of the expansion gas/moisture mixture when the exhaust valve opens. The range of MEP steam calculated for the geometry of a conventional gasoline engine and is from 0.75 to 2.5 bars. Typical combustion mean effective pressures (MEP combustion ) of naturally aspirated gasoline engines are up to 10 bar, thus this concept has the potential to significantly increase the engine efficiency and fuel economy.

  12. Association Between Macrominerals Intake and Changes in Internal Carotid Artery-Intima Media Thickness in POST Ischemic Stroke Patients

    Science.gov (United States)

    Pudjonarko, Dwi; Tugasworo, Dodik; Silaen, Rumintang

    2017-02-01

    Carotid Intima Media Thickness (C-IMT) has been widely used as marker for atherosclerosis. Previous studies on minerals intake and its association with C-IMT revealed various. Most of the studies showed inconsistent results. The aim of this study is to determine wether macro minerals intake is related to internal carotid-intima media thickness (IC-IMT). This is a longitudinal study, pre test post test design conducted in Neurology clinic, Kariadi hospital, Semarang from June to December 2014. Subjects were 22 post ischemic stroke patients. Minerals intake and IC-IMT was measured using Food Frequency Questionnaire and Duplex Carotid Ultrasonography. Statistical analysis was performed using Chi-Square, Fisher Exact and Logistic Regression test. Subjects included in this study were 17 male subjects (77.3%) and 5 female subjects (22.7%). Mean of IC-IMT in female subjects was found to be higher than in male. Mean of total IC-IMT was increased after a period of six months (0.96±0.80 to 0.97±0.21 mm). There were significant association between calcium as well as sodium intakes and IC-IMT. In contrast, there were no association between magnesium as well as potassium intake and IC-IMT. Multivariate analysis suggest that sodium intake (OR=26.828) was the most influencing factor for IC-IMT, followed by calcium intake (OR=0.042). Calcium as well as potassium intake were independently associated with IC-IMT. Magnecium as well as sodium intake were not independently associated with IC-IMT changes. Sodium intake was the most influencing variable to IC-IMT changes, followed by calcium intake.

  13. STROKOG (stroke and cognition consortium): An international consortium to examine the epidemiology, diagnosis, and treatment of neurocognitive disorders in relation to cerebrovascular disease.

    Science.gov (United States)

    Sachdev, Perminder S; Lo, Jessica W; Crawford, John D; Mellon, Lisa; Hickey, Anne; Williams, David; Bordet, Régis; Mendyk, Anne-Marie; Gelé, Patrick; Deplanque, Dominique; Bae, Hee-Joon; Lim, Jae-Sung; Brodtmann, Amy; Werden, Emilio; Cumming, Toby; Köhler, Sebastian; Verhey, Frans R J; Dong, Yan-Hong; Tan, Hui Hui; Chen, Christopher; Xin, Xu; Kalaria, Raj N; Allan, Louise M; Akinyemi, Rufus O; Ogunniyi, Adesola; Klimkowicz-Mrowiec, Aleksandra; Dichgans, Martin; Wollenweber, Frank A; Zietemann, Vera; Hoffmann, Michael; Desmond, David W; Linden, Thomas; Blomstrand, Christian; Fagerberg, Björn; Skoog, Ingmar; Godefroy, Olivier; Barbay, Mélanie; Roussel, Martine; Lee, Byung-Chul; Yu, Kyung-Ho; Wardlaw, Joanna; Makin, Stephen J; Doubal, Fergus N; Chappell, Francesca M; Srikanth, Velandai K; Thrift, Amanda G; Donnan, Geoffrey A; Kandiah, Nagaendran; Chander, Russell J; Lin, Xuling; Cordonnier, Charlotte; Moulin, Solene; Rossi, Costanza; Sabayan, Behnam; Stott, David J; Jukema, J Wouter; Melkas, Susanna; Jokinen, Hanna; Erkinjuntti, Timo; Mok, Vincent C T; Wong, Adrian; Lam, Bonnie Y K; Leys, Didier; Hénon, Hilde; Bombois, Stéphanie; Lipnicki, Darren M; Kochan, Nicole A

    2017-01-01

    The Stroke and Cognition consortium (STROKOG) aims to facilitate a better understanding of the determinants of vascular contributions to cognitive disorders and help improve the diagnosis and treatment of vascular cognitive disorders (VCD). Longitudinal studies with ≥75 participants who had suffered or were at risk of stroke or TIA and which evaluated cognitive function were invited to join STROKOG. The consortium will facilitate projects investigating rates and patterns of cognitive decline, risk factors for VCD, and biomarkers of vascular dementia. Currently, STROKOG includes 25 (21 published) studies, with 12,092 participants from five continents. The duration of follow-up ranges from 3 months to 21 years. Although data harmonization will be a key challenge, STROKOG is in a unique position to reuse and combine international cohort data and fully explore patient level characteristics and outcomes. STROKOG could potentially transform our understanding of VCD and have a worldwide impact on promoting better vascular cognitive outcomes.

  14. Virtual Sustainability

    Directory of Open Access Journals (Sweden)

    William Sims Bainbridge

    2010-09-01

    Full Text Available In four ways, massively multiplayer online role-playing games may serve as tools for advancing sustainability goals, and as laboratories for developing alternatives to current social arrangements that have implications for the natural environment. First, by moving conspicuous consumption and other usually costly status competitions into virtual environments, these virtual worlds might reduce the need for physical resources. Second, they provide training that could prepare individuals to be teleworkers, and develop or demonstrate methods for using information technology to replace much transportation technology, notably in commuting. Third, virtual worlds and online games build international cooperation, even blending national cultures, thereby inching us toward not only the world consciousness needed for international agreements about the environment, but also toward non-spatial government that cuts across archaic nationalisms. Finally, realizing the potential social benefits of this new technology may urge us to reconsider a number of traditional societal institutions.

  15. VIRTUAL REALITY: U.S. INFORMATION SECURITY THREATS CONCEPT AND ITS INTERNATIONAL DIMENSION

    Directory of Open Access Journals (Sweden)

    Elena Vladimirovna Batueva

    2014-01-01

    Full Text Available The development of ICT and the formation of the global information space changed the agenda of national and international security. Such key characteristics of cyberspace as openness, accessibility, anonymity, and identification complexity determined the rise of actors in cyber space and increased the level of cyber threats. Based on the analyses of the U.S. agencies' approach, the author defines three major groups of threats: use of ICT by states, criminals and terrorists. This concept is shared by the majority of the countries involved in the international dialogue on information security issues and is fundamental for providing cyber security policy on both national and international levels. The United States is developing a complex strategy for cyber space that includes maximization of ICT's advantages in all strategically important fields as well as improvement of national information systems and networks security. On the international level the main task for the American diplomacy is to guarantee the U.S. information dominance. The United States is the only country that takes part practically in all international and regional fora dealing with cyber security issues. However process of the development of a global cyber security regime is not going to be fast due to countries' different approaches to key definitions and lack of joint understanding of cyber security issues as well as due to the position of the countries, among all the United States, that are not interested in any new obligatory international norms and principles. Such American policy aims at saving the possibility of using cyberspace capacity in reaching political and military goals, thus keeping the global leadership.

  16. Virtual Reality: U.S. Information Security Threats Concept And Its International Dimension

    Directory of Open Access Journals (Sweden)

    Elena Vladimirovna Batueva

    2014-01-01

    Full Text Available The development of ICT and the formation of the global information space changed the agenda of national and international security. Such key characteristics of cyberspace as openness, accessibility, anonymity, and identification complexity determined the rise of actors in cyber space and increased the level of cyber threats. Based on the analyses of the U.S. agencies' approach, the author defines three major groups of threats: use of ICT by states, criminals and terrorists. This concept is shared by the majority of the countries involved in the international dialogue on information security issues and is fundamental for providing cyber security policy on both national and international levels. The United States is developing a complex strategy for cyber space that includes maximization of ICT's advantages in all strategically important fields as well as improvement of national information systems and networks security. On the international level the main task for the American diplomacy is to guarantee the U.S. information dominance. The United States is the only country that takes part practically in all international and regional fora dealing with cyber security issues. However process of the development of a global cyber security regime is not going to be fast due to countries' different approaches to key definitions and lack of joint understanding of cyber security issues as well as due to the position of the countries, among all the United States, that are not interested in any new obligatory international norms and principles. Such American policy aims at saving the possibility of using cyberspace capacity in reaching political and military goals, thus keeping the global leadership.

  17. Virtual international experiences in veterinary medicine: an evaluation of students' attitudes toward computer-based learning.

    Science.gov (United States)

    French, Brigitte C; Hird, David W; Romano, Patrick S; Hayes, Rick H; Nijhof, Ard M; Jongejan, Frans; Mellor, Dominic J; Singer, Randall S; Fine, Amanda E; Gay, John M; Davis, Radford G; Conrad, Patricia A

    2007-01-01

    While many studies have evaluated whether or not factual information can be effectively communicated using computer-aided tools, none has focused on establishing and changing students' attitudes toward international animal-health issues. The study reported here was designed to assess whether educational modules on an interactive computer CD elicited a change in veterinary students' interest in and attitudes toward international animal-health issues. Volunteer veterinary students at seven universities (first-year students at three universities, second-year at one, third-year at one, and fourth-year at two) were given by random assignment either an International Animal Health (IAH) CD or a control CD, ParasitoLog (PL). Participants completed a pre-CD survey to establish baseline information on interest and attitudes toward both computers and international animal-health issues. Four weeks later, a post-CD questionnaire was distributed. On the initial survey, most students expressed an interest in working in the field of veterinary medicine in another country. Responses to the three pre-CD questions relating to attitudes toward the globalization of veterinary medicine, interest in foreign animal disease, and inclusion of a core course on international health issues in the veterinary curriculum were all positive, with average values above 3 (on a five-point scale where 5 represented strong agreement or interest). Almost all students considered it beneficial to learn about animal-health issues in other countries. After students reviewed the IAH CD, we found a decrease at four universities, an increase at one university, and no change at the remaining two universities in students' interest in working in some area of international veterinary medicine. However, none of the differences was statistically significant.

  18. Virtual communities in a secondary school – Discovering the internal grammar of video games

    Directory of Open Access Journals (Sweden)

    Laura Méndez

    2014-01-01

    Full Text Available This study attempts to show how the creation of an innovative scenario, introducing video games and online communities as educational resources in the classroom, facilitates the development of new literacies in the context of participatory culture. The experience described was carried out during the 2010-2011 academic year in a secondary school located in Madrid. The workshop was organized using a social simulation video game, The Sims 3, and the online community Play and Learn, created specifically for this project. From an ethnographic perspective, the article focuses mainly on analyzing what happened outside the game sessions, when the students became involved in the online community after interacting with the game in the classroom. The fact that they participated in a virtual conversational space (through a forum serves to support the game and encourage reflection from all participants. The results show that social relationships were developed within the online community, where individual contributions proved especially important for group discussion. Participation made it possible for students to become aware of the speech and rules of the game and to improve the acquisition process of new literacies.

  19. Gross efficiency during rowing is not affected by stroke rate

    NARCIS (Netherlands)

    Hofmijster, M.J.; van Soest, A.J.; de Koning, J.J.

    2009-01-01

    Purpose: It has been suggested that the optimal stroke rate in rowing is partly determined by the stroke-rate dependence of internal power losses. This should be reflected in a stroke-rate dependency of gross efficiency (e

  20. VIRTUAL REALITY: U.S. INFORMATION SECURITY THREATS CONCEPT AND ITS INTERNATIONAL DIMENSION

    OpenAIRE

    Elena Vladimirovna Batueva

    2014-01-01

    The development of ICT and the formation of the global information space changed the agenda of national and international security. Such key characteristics of cyberspace as openness, accessibility, anonymity, and identification complexity determined the rise of actors in cyber space and increased the level of cyber threats. Based on the analyses of the U.S. agencies' approach, the author defines three major groups of threats: use of ICT by states, criminals and terrorists. This concept is sh...

  1. Measuring patterns of disability using the International Classification of Functioning, Disability and Health in the post-acute stroke rehabilitation setting.

    Science.gov (United States)

    Goljar, Nika; Burger, Helena; Vidmar, Gaj; Leonardi, Matilde; Marincek, Crt

    2011-06-01

    To determine whether the International Classification of Functioning, Disability and Health (ICF) model is adequate for assessing disability patterns in stroke survivors in the sub-acute rehabilitation setting in terms of potential changes in functional profiles over time. Functional profiles of 197 stroke patients were assessed using the ICF Checklist and the Functional Independence Measure (FIMTM) at admission and discharge from rehabilitation hospital. The ICF Checklist was applied based on medical documentation and rehabilitation team meetings. Descriptive analyses were performed to identify changes in ICF categories and qualifiers from admission to discharge, and correlations between different improvement measures were calculated. Mean rehabilitation duration was 60 days; patients' mean age was 60 years, with mean FIM-score 75 at admission. Mean FIM-score improvement at discharge was 12.5. Within Body Functions, changes in at least 10% of patients were found regarding 13 categories; no categories within Body Structures, 24 within Activities and Participation, and 2 within Environmental Factors. Changes were mostly due to improvement in qualifiers, except for within Environmental Factors, where they were due to use of additional categories. Correlations between improvements in Body Functions and Activities and Participation (regarding capacity and performance), as well as between capacity and performance within Activities and Participation, were approximately 0.4. Rating ICF categories with qualifiers enables the detection of changes in functional profiles of stroke patients who underwent an inpatient rehabilitation programme. :

  2. Motor skill changes and neurophysiologic adaptation to recovery-oriented virtual rehabilitation of hand function in a person with subacute stroke: a case study.

    Science.gov (United States)

    Fluet, Gerard G; Patel, Jigna; Qiu, Qinyin; Yarossi, Matthew; Massood, Supriya; Adamovich, Sergei V; Tunik, Eugene; Merians, Alma S

    2017-07-01

    The complexity of upper extremity (UE) behavior requires recovery of near normal neuromuscular function to minimize residual disability following a stroke. This requirement places a premium on spontaneous recovery and neuroplastic adaptation to rehabilitation by the lesioned hemisphere. Motor skill learning is frequently cited as a requirement for neuroplasticity. Studies examining the links between training, motor learning, neuroplasticity, and improvements in hand motor function are indicated. This case study describes a patient with slow recovering hand and finger movement (Total Upper Extremity Fugl-Meyer examination score = 25/66, Wrist and Hand items = 2/24 on poststroke day 37) following a stroke. The patient received an intensive eight-session intervention utilizing simulated activities that focused on the recovery of finger extension, finger individuation, and pinch-grasp force modulation. Over the eight sessions, the patient demonstrated improvements on untrained transfer tasks, which suggest that motor learning had occurred, as well a dramatic increase in hand function and corresponding expansion of the cortical motor map area representing several key muscles of the paretic hand. Recovery of hand function and motor map expansion continued after discharge through the three-month retention testing. This case study describes a neuroplasticity based intervention for UE hemiparesis and a model for examining the relationship between training, motor skill acquisition, neuroplasticity, and motor function changes. Implications for rehabilitation Intensive hand and finger rehabilitation activities can be added to an in-patient rehabilitation program for persons with subacute stroke. Targeted training of the thumb may have an impact on activity level function in persons with upper extremity hemiparesis. Untrained transfer tasks can be utilized to confirm that training tasks have elicited motor learning. Changes in cortical motor maps can be used to document

  3. A Mixed Methods Small Pilot Study to Describe the Effects of Upper Limb Training Using a Virtual Reality Gaming System in People with Chronic Stroke

    Directory of Open Access Journals (Sweden)

    Rachel C. Stockley

    2017-01-01

    Full Text Available Introduction. This small pilot study aimed to examine the feasibility of an upper limb rehabilitation system (the YouGrabber in a community rehabilitation centre, qualitatively explore participant experiences, and describe changes after using it. Methods and Material. Chronic stroke participants attending a community rehabilitation centre in the UK were randomised to either a YouGrabber or a gym group and completed 18 training sessions over 12 weeks. The motor activity log, box and block, and fatigue severity score were administered by a blinded assessor before and after the intervention. Semistructured interviews were used to ascertain participants’ views about using the YouGrabber. Results. Twelve participants (6 females with chronic stroke were recruited. All adhered to the intervention. There were no adverse events, dropouts, or withdrawal. There were no significant differences between the YouGrabber and gym groups although there were significant within group improvements on the motor activity log (median change: 0.59, range: 0.2–1.25; p<0.05 within the YouGrabber group. Participants reported that the YouGrabber was motivational but they expressed frustration with technical challenges. Conclusions. The YouGrabber appeared practical and may improve upper limb activities in people several months after stroke. Future work could examine cognition, cost effectiveness, and different training intensities.

  4. A Mixed Methods Small Pilot Study to Describe the Effects of Upper Limb Training Using a Virtual Reality Gaming System in People with Chronic Stroke.

    Science.gov (United States)

    Stockley, Rachel C; O'Connor, Deborah A; Smith, Phil; Moss, Sylvia; Allsop, Lizzie; Edge, Wendy

    2017-01-01

    Introduction . This small pilot study aimed to examine the feasibility of an upper limb rehabilitation system (the YouGrabber) in a community rehabilitation centre, qualitatively explore participant experiences, and describe changes after using it. Methods and Material . Chronic stroke participants attending a community rehabilitation centre in the UK were randomised to either a YouGrabber or a gym group and completed 18 training sessions over 12 weeks. The motor activity log, box and block, and fatigue severity score were administered by a blinded assessor before and after the intervention. Semistructured interviews were used to ascertain participants' views about using the YouGrabber. Results . Twelve participants (6 females) with chronic stroke were recruited. All adhered to the intervention. There were no adverse events, dropouts, or withdrawal. There were no significant differences between the YouGrabber and gym groups although there were significant within group improvements on the motor activity log (median change: 0.59, range: 0.2-1.25; p < 0.05) within the YouGrabber group. Participants reported that the YouGrabber was motivational but they expressed frustration with technical challenges. Conclusions . The YouGrabber appeared practical and may improve upper limb activities in people several months after stroke. Future work could examine cognition, cost effectiveness, and different training intensities.

  5. Isokinetic dynamometry on the internal rotator and adductor muscles of the swimmers' shoulders: no differences between asymmetrical and symmetrical swimming strokes

    OpenAIRE

    Secchi, Leonardo Luiz Barretti; Brech, Guilherme Carlos; Greve, Júlia Maria D'Andréa

    2015-01-01

    OBJECTIVE: In this study, we compare muscular strength of the internal rotators and adductors of the shoulder between asymmetrical (backstroke and freestyle) and symmetrical (breaststroke and butterfly) swimming strokes. METHOD: We evaluated: shoulders of (a) asymmetrical swimmers (aged 21.8 ± 3.8 years), (b) symmetrical swimmers (aged 20.3 ± 4.5 years), (c) recreational swimmers (aged 24.5 ± 4.5 years), and (d) control individuals (aged 25.8 ± 3.5 years). All evaluations were performed on a...

  6. Carotid stiffness indicates risk of ischemic stroke and TIA in patients with internal carotid artery stenosis: the SMART study

    NARCIS (Netherlands)

    Dijk, Joke M.; van der Graaf, Yolanda; Grobbee, Diederick E.; Bots, Michiel L.

    2004-01-01

    Patients with a carotid artery stenosis, including those with an asymptomatic or moderate stenosis, have a considerable risk of ischemic stroke. Identification of risk factors for cerebrovascular disease in these patients may improve risk profiling and guide new treatment strategies. We

  7. Stay Focused! The Effects of Internal and External Focus of Attention on Movement Automaticity in Patients with Stroke

    NARCIS (Netherlands)

    Kal, E. C.; van der Kamp, J.; Houdijk, H.; Groet, E.; van Bennekom, C. A. M.; Scherder, E. J. A.

    2015-01-01

    Dual-task performance is often impaired after stroke. This may be resolved by enhancing patients' automaticity of movement. This study sets out to test the constrained action hypothesis, which holds that automaticity of movement is enhanced by triggering an external focus (on movement effects),

  8. Late night activity regarding stroke codes: LuNAR strokes.

    Science.gov (United States)

    Tafreshi, Gilda; Raman, Rema; Ernstrom, Karin; Rapp, Karen; Meyer, Brett C

    2012-08-01

    similarity was further supported in similar rates of tissue plasminogen activator administration. Late night strokes may warrant a more rapid stroke specialist evaluation due to the longer time elapsed from symptom onset and the longer time to computed tomography scan. © 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.

  9. Seeing and identifying with a virtual body decreases pain perception.

    Science.gov (United States)

    Hänsel, Alexander; Lenggenhager, Bigna; von Känel, Roland; Curatolo, Michele; Blanke, Olaf

    2011-09-01

    Pain and the conscious mind (or the self) are experienced in our body. Both are intimately linked to the subjective quality of conscious experience. Here, we used virtual reality technology and visuo-tactile conflicts in healthy subjects to test whether experimentally induced changes of bodily self-consciousness (self-location; self-identification) lead to changes in pain perception. We found that visuo-tactile stroking of a virtual body but not of a control object led to increased pressure pain thresholds and self-location. This increase was not modulated by the synchrony of stroking as predicted based on earlier work. This differed for self-identification where we found as predicted that synchrony of stroking increased self-identification with the virtual body (but not a control object), and positively correlated with an increase in pain thresholds. We discuss the functional mechanisms of self-identification, self-location, and the visual perception of human bodies with respect to pain perception. Copyright © 2011 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.

  10. Reproducibility of the items on the Stroke Specific Quality of Life questionnaire that evaluate the participation component of the International Classification of Functioning, Disability and Health.

    Science.gov (United States)

    Silva, Soraia Micaela; Corrêa, Fernanda Ishida; Faria, Christina Danielli Coelho de Morais; Pereira, Gabriela Santos; Attié, Edna Alves Dos Anjos; Corrêa, João Carlos Ferrari

    2016-12-01

    To evaluate the reproducibility of the Stroke Specific Quality of Life (SS-QOL) items that address the participation component of the International Classification of Functioning, Disability and Health (ICF) and analyse the correlation between the subscore of these 26 items and the total SS-QOL score. Seventy-five stroke survivors participated in this study. Reproducibility was evaluated using the intraclass correlation coefficient (ICC2,1), standard error of measurement (SEM), minimum detectable change (MDC) and the Bland-Altman plot. The correlation between the subscore of the 26 items and the total SS-QOL score was analysed using Spearman's correlation coefficients (rho) and simple linear regression. An alpha risk ≤ 0.05 was considered for all analyses. The SS-QOL items that address the participation component of the ICF demonstrated excellent reliability (intra-rater ICC2,1 = 0.96; inter-rater ICC2,1 = 0.95). The SEM and MDC were adequate. The Bland-Altman plot demonstrated satisfactory agreement. A significant and strong correlation (rho = 0.83) was found between the 26 SS-QOL items that address participation and the total SS-QOL score. Moreover, the evaluation of participation was found to explain 73% of the evaluation of health-related quality of life. The 26 SS-QOL items that address the participation component of the ICF demonstrated adequate reproducibility. Thus, participation, which represents the social aspects of functionality, can be adequately evaluated with these items. Implications for Rehabilitation The 26 Stroke Specific Quality of Life items that address participation proved to be reproducible for the analysis of social participation following a stroke. The findings can lead to a better understanding of the social participation of individuals with chronic hemiparesis and assist in the establishment of adequate treatment for such individuals. The rehabilitation process can be directed towards more specific goals focused on the

  11. Stroke in tuberculous meningitis.

    Science.gov (United States)

    Misra, Usha Kant; Kalita, Jayantee; Maurya, Pradeep Kumar

    2011-04-15

    Stroke in tuberculous meningitis (TBM) occurs in 15-57% of patients especially in advance stage and severe illness. The majority of strokes may be asymptomatic because of being in a silent area, deep coma or associated pathology such as spinal arachnoiditis or tuberculoma. Methods of evaluation also influence the frequency of stroke. MRI is more sensitive in detecting acute (DWI) and chronic (T2, FLAIR) stroke. Most of the strokes in TBM are multiple, bilateral and located in the basal ganglia especially the 'tubercular zone' which comprises of the caudate, anterior thalamus, anterior limb and genu of the internal capsule. These are attributed to the involvement of medial striate, thalamotuberal and thalamostriate arteries which are embedded in exudates and likely to be stretched by a coexistent hydrocephalus. Cortical stroke can also occur due to the involvement of proximal portion of the middle, anterior and posterior cerebral arteries as well as the supraclinoid portion of the internal carotid and basilar arteries which are documented in MRI, angiography and autopsy studies. Arteritis is more common than infarction in autopsy study. The role of cytokines especially tumor necrosis factor (TNFα), vascular endothelial growth factor (VEGF) and matrix metaloproteineases (MMPs) in damaging the blood brain barrier, attracting leucocytes and release of vasoactive autocoids have been suggested. The prothrombotic state may also contribute to stroke in TBM. Corticosteroids with antitubercular therapy were thought to reduce mortality and morbidity but their role in reducing strokes has not been proven. Aspirin also reduces mortality and its role in reducing stroke in TBM needs further studies. Copyright © 2010 Elsevier B.V. All rights reserved.

  12. Ischemic Stroke

    Science.gov (United States)

    ... Workplace Giving Fundraise Planned Giving Corporate Giving Cause Marketing Join your team, your way! The Stroke Challenge ... Your Technology Guide High Blood Pressure and Stroke Importance of Physical Activity See More Multimedia Las minorías ...

  13. Paediatric stroke

    African Journals Online (AJOL)

    2011-04-02

    Apr 2, 2011 ... Organization definition of stroke is 'a clinical syndrome of rapidly developing focal or global ..... In the case of sickle cell disease primary and secondary prevention is by ... stroke and must involve caregivers. Prognosis7,10,17.

  14. Upper extremity function in stroke subjects: relationships between the international classification of functioning, disability, and health domains.

    Science.gov (United States)

    Faria-Fortini, Iza; Michaelsen, Stella Maris; Cassiano, Janine Gomes; Teixeira-Salmela, Luci Fuscaldi

    2011-01-01

    Upper limb (UL) impairments are the most common disabling deficits after stroke and have complex relationships with activity and participation domains. However, relatively few studies have applied the ICF model to identify the contributions of specific UL impairments, such as muscular weakness, pain, and sensory loss, as predictors of activity and participation. The purposes of this predictive study were to evaluate the relationships between UL variables related to body functions/structures, activity, and participation domains and to determine which would best explain activity and participation with 55 subjects with chronic stroke. Body functions/structures were assessed by measures of grip, pinch, and UL strength, finger tactile sensations, shoulder pain, and cognition (MMSE); activity domain by measures of observed performance (BBT, NHPT, and TEMPA); and participation by measures of quality of life (SSQOL). Upper-limb and grip strength were related to all activity measures (0.52 stroke subjects. 2c. Copyright © 2011 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  15. ATLAS virtual visit features Birzeit University, first university in Palestine and a member of the International Association of Universities since 1977.

    CERN Multimedia

    claudia marcelloni

    2012-01-01

    This ATLAS virtual visit features Birzeit University, first university in Palestine and a member of the International Association of Universities since 1977. As part of the "Physics Without Frontiers" project, funded by the International Centre for Theoretical Physics (ICTP), Birzeit is hosting a one day particle physics masterclass. During the day the physics major students are given an introduction to experimental particle physics, the LHC and the ATLAS Experiment, before having the chance to analyze real LHC data. This virtual visit comprises of a live tour around the ATLAS control room and the opportunity to ask questions to the ATLAS physicists. The Department of Physics at Birzeit University provides an exciting environment for the training of both graduate and undergraduate students. Some of the Physics department graduates participated in the CERN Summer Program over the past few years.

  16. Cryptogenic Stroke

    Directory of Open Access Journals (Sweden)

    Mohammad Saadatnia

    2017-02-01

    Full Text Available Cryptogenic stroke is defined as brain infarction that is not attributable to a source of definite embolism, large artery atherosclerosis, or small artery disease despite a thorough vascular, cardiac, and serologic evaluation. Despite many advances in our understanding of ischemic stroke, cryptogenic strokes remain a diagnostic and therapeutic challenge. The pathophysiology of cryptogenic stroke is likely various. Probable mechanisms include cardiac embolism secondary to occult paroxysmal atrial fibrillation, aortic atheromatous disease or other cardiac sources, paradoxical embolism from atrial septal abnormalities such as patent foramen ovale, hypercoagulable states, and preclinical or subclinical cerebrovascular disease.  Cryptogenic stroke is one-fourth among cerebral infarction, but most of them could be ascribed to embolic stroke. A significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging and improvement in our ability to detect paroxysmal atrial fibrillation in patients with cryptogenic stroke has strengthened the idea that these strokes are embolic in nature. a significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging.embolic stroke of undetermined sources(ESUS was planned for unifying embolic stroke of undetermined source.  The etiologies underlying ESUS included minor-risk potential cardioembolic sources, covert paroxysmal atrial fibrillation, cancer-associated coagulopathy and embolism, arteriogenic emboli, and paroxysmal embolism. Extensive evaluation including transesophageal echocardiography and cardiac monitoring for long time could identify the etiology of these patients. Therefore cryptogenic stroke is a diagnosis of exclusion. Compared with other stroke subtypes, cryptogenic stroke tends to have a better prognosis and lower long-term risk of recurrence.

  17. [Ischemic stroke in young women

    NARCIS (Netherlands)

    Ekker, M.S.; Wermer, M.J.; Riksen, N.P.; Klijn, C.J.; Leeuw, F.E. de

    2016-01-01

    - In virtually all age groups, the incidence of ischemic stroke is higher in men. However, in women aged between 25-49 years the prevalence is higher than in men. Female-specific risk factors and disorders may explain this peak.- Pregnancy and the post-partum period are associated with physiological

  18. Virtually teaching virtual leadership

    DEFF Research Database (Denmark)

    Henriksen, Thomas Duus; Nielsen, Rikke Kristine; Børgesen, Kenneth

    2017-01-01

    This paper seeks to investigate the challenges to virtual collaboration and leadership on basis of findings from a virtual course on collaboration and leadership. The course used for this experiment was designed as a practical approach, which allowed participants to experience curriculum phenomena....... This experimental course provided insights into the challenges involved in virtual processes, and those experiences where used for addressing the challenges that virtual leadership is confronted with. Emphasis was placed on the reduction of undesired virtual distance and its consequences through affinity building....... We found that student scepticism appeared when a breakdown resulted in increasing virtual distance, and raises questions on how leaders might translate or upgrade their understandings of leadership to handling such increased distance through affinity building....

  19. Validation of an immersive virtual reality system for training near and far space neglect in individuals with stroke: a pilot study.

    Science.gov (United States)

    Yasuda, Kazuhiro; Muroi, Daisuke; Ohira, Masahiro; Iwata, Hiroyasu

    2017-10-01

    Unilateral spatial neglect (USN) is defined as impaired ability to attend and see on one side, and when present, it interferes seriously with daily life. These symptoms can exist for near and far spaces combined or independently, and it is important to provide effective intervention for near and far space neglect. The purpose of this pilot study was to propose an immersive virtual reality (VR) rehabilitation program using a head-mounted display that is able to train both near and far space neglect, and to validate the immediate effect of the VR program in both near and far space neglect. Ten USN patients underwent the VR program with a pre-post design and no control. In the virtual environment, we developed visual searching and reaching tasks using an immersive VR system. Behavioral inattention test (BIT) scores obtained pre- and immediate post-VR program were compared. BIT scores obtained pre- and post-VR program revealed that far space neglect but not near space neglect improved promptly after the VR program. This effect for far space neglect was observed in the cancelation task, but not in the line bisection task. Positive effects of the immersive VR program for far space neglect are suggested by the results of the present pilot study. However, further studies with rigorous designs are needed to validate its clinical effectiveness.

  20. Impact of SAMMPRIS on the future of intracranial atherosclerotic disease management: polling results from the ICAD symposium at the International Stroke Conference.

    Science.gov (United States)

    Zaidat, Osama O; Castonguay, Alicia C; Nguyen, Thanh N; Becker, Kyra J; Derdeyn, Colin P; Nelson, Peter K; Amarenco, Pierre; Brott, Thomas G

    2014-04-01

    There are few data regarding the effect of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial results on the management of intracranial atherosclerotic disease (ICAD). We sought to understand the impact of the SAMMPRIS trial on current ICAD clinical practices and future trial design. During the ICAD symposium at the 2012 International Stroke Conference, electronic data were collected regarding attendees' clinical management of ICAD and opinions on the feasibility of future trials post-SAMMPRIS. 217 attendees from different specialties, including neurologists (57%), neurointerventionalists (9%) and neurosurgeons (5%), participated in the session. The majority of respondents (77%) indicated that the results of SAMMPRIS have impacted their consideration for intracranial stenting. Post-SAMMPRIS, 84% selected 'SAMMPRIS-style' medical management for the treatment of ICAD. For patients with ICAD who failed aggressive medical therapy, 82% would consider an alternative approach to continuing medical therapy (30% considered clinical trial enrollment, 28% suggested angioplasty and stenting and 24% angioplasty). The majority of participants (85%) were willing to randomize patients with symptomatic ICAD in future trials. For the next ICAD trial, 29% indicated that angioplasty alone should be compared with aggressive medical therapy. Our polling results suggest that the SAMMPRIS trial has had an impact on the current treatment of ICAD. Treatment of patients who failed medical therapy varied widely from aggressive medical therapy to balloon angioplasty, stenting or enrollment in future clinical trials. The willingness to continue clinical trials and randomize patients supports the need for future ICAD studies.

  1. Combined Transcranial Direct Current Stimulation and Virtual Reality-Based Paradigm for Upper Limb Rehabilitation in Individuals with Restricted Movements. A Feasibility Study with a Chronic Stroke Survivor with Severe Hemiparesis.

    Science.gov (United States)

    Fuentes, María Antonia; Borrego, Adrián; Latorre, Jorge; Colomer, Carolina; Alcañiz, Mariano; Sánchez-Ledesma, María José; Noé, Enrique; Llorens, Roberto

    2018-04-02

    Impairments of the upper limb function are a major cause of disability and rehabilitation. Most of the available therapeutic options are based on active exercises and on motor and attentional inclusion of the affected arm in task oriented movements. However, active movements may not be possible after severe impairment of the upper limbs. Different techniques, such as mirror therapy, motor imagery, and non-invasive brain stimulation have been shown to elicit cortical activity in absence of movements, which could be used to preserve the available neural circuits and promote motor learning. We present a virtual reality-based paradigm for upper limb rehabilitation that allows for interaction of individuals with restricted movements from active responses triggered when they attempt to perform a movement. The experimental system also provides multisensory stimulation in the visual, auditory, and tactile channels, and transcranial direct current stimulation coherent to the observed movements. A feasibility study with a chronic stroke survivor with severe hemiparesis who seemed to reach a rehabilitation plateau after two years of its inclusion in a physical therapy program showed clinically meaningful improvement of the upper limb function after the experimental intervention and maintenance of gains in both the body function and activity. The experimental intervention also was reported to be usable and motivating. Although very preliminary, these results could highlight the potential of this intervention to promote functional recovery in severe impairments of the upper limb.

  2. Stroke Prevention Trials in Sickle Cell Anemia

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2006-06-01

    Full Text Available As part of an International Pediatric Stroke Study launched in 2002, the Stroke Prevention Trial in Sickle Cell Anemia (STOP reports a reduction in the number of overt clinical strokes in children with critically high transcranial Doppler velocities (>200 cm/sec who were regularly transfused.

  3. A computational fluid dynamics analysis on stratified scavenging system of medium capacity two-stroke internal combustion engines

    Directory of Open Access Journals (Sweden)

    Pitta Srinivasa Rao

    2008-01-01

    Full Text Available The main objective of the present work is to make a computational study of stratified scavenging system in two-stroke medium capacity engines to reduce or to curb the emissions from the two-stroke engines. The 3-D flows within the cylinder are simulated using computational fluid dynamics and the code Fluent 6. Flow structures in the transfer ports and the exhaust port are predicted without the stratification and with the stratification, and are well predicted. The total pressure and velocity map from computation provided comprehensive information on the scavenging and stratification phenomenon. Analysis is carried out for the transfer ports flow and the extra port in the transfer port along with the exhaust port when the piston is moving from the top dead center to the bottom dead center, as the ports are closed, half open, three forth open, and full port opening. An unstructured cell is adopted for meshing the geometry created in CATIA software. Flow is simulated by solving governing equations namely conservation of mass momentum and energy using SIMPLE algorithm. Turbulence is modeled by high Reynolds number version k-e model. Experimental measurements are made for validating the numerical prediction. Good agreement is observed between predicted result and experimental data; that the stratification had significantly reduced the emissions and fuel economy is achieved.

  4. Comprehensive stroke units: a review of comparative evidence and experience.

    Science.gov (United States)

    Chan, Daniel K Y; Cordato, Dennis; O'Rourke, Fintan; Chan, Daniel L; Pollack, Michael; Middleton, Sandy; Levi, Chris

    2013-06-01

    . © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

  5. A method of controlling a large two-stroke turbocharged internal combustion engine and an engine for use in this method

    Energy Technology Data Exchange (ETDEWEB)

    Kjemtrup, N; Grone, O S

    1994-03-03

    A large two-stroke turbocharged internal combusted engine has a reactor for reduction of the NO[sub x]-content in the exhaust gas connected upstream of the turbocharger. At least one sensor measures at least one engine parameter and in a control unit it is determined whether the reactor is heated by the exhaust gas, which heating may cause reduced energy supply to the turbocharger. When this is the case the control unit opens for supply of supplementary air or gas to the engine which may be effected by starting an auxiliary blower and/or by actuating a control means in a bypass conduit so that a large amount of exhaust gas with a corresponding increase in the power is delivered to the turbocharger turbine. (author) figs.

  6. Virtual materiality

    DEFF Research Database (Denmark)

    Søndergaard, Dorte Marie

    as their recounts of them and 3. the consumption of other media products like movies, reality shows, YouTube videos etc. How do we theorize ‘matter’ in such dimensions? Is it possible to theorize virtual matter as ‘materiality’ in line with any real life materiality? What conceptualization will help us understand......? These questions become crucial when we follow matter in and across real life, virtual experience, recounted imagery, night dreams, YouTube videos and even further. Some may already have recognized Phillip’s skeleton army as a transport/transformation from Lord of the Rings, DVD 3, the army which Aragon calls out....... Butler, J. (1993) Bodies that Matter. On the Discursive Limits of “Sex”. London: Routledge. Durkin, K. et al. (1998) Children, Media and Agression. Current Research in Australia and New Zealand. In: Carlson, U. & von Feilitzen, C. (red): Children and Media Violence. Yearbook from the UNESCO International...

  7. Rehabilitative Games for Stroke Patients

    Directory of Open Access Journals (Sweden)

    A. Pyae

    2015-07-01

    Full Text Available Stroke is one of the major problems in medical and healthcare that can cause severe disability and death of patients especially for older population. Rehabilitation plays an important role in stroke therapy. However, most of the rehabilitative exercises are monotonous and tiring for the patients. For a particular time, they can easily get bored in doing these exercises. The role of patient’s motivation in rehabilitation is vital. Motivation and rehabilitative outcomes are strongly related. Digital games promise to help stroke patients to feel motivated and more engaged in rehabilitative training through motivational gameplay. Most of the commercial games available in the market are not well-designed for stroke patients and their motivational needs in rehabilitation. This study aims at understanding the motivational requirements of stroke patients in doing rehabilitative exercises and living in a post-stroke life. Based on the findings from the literature review, we report factors that can influence the stroke patients’ level of motivation such as social functioning, patient-therapist relationship, goal-setting, and music. These findings are insightful and useful for ideating and designing interactive motivation-driven games for stroke patients. The motivational factors of stroke patients in rehabilitation may help the game designers to design motivation-driven game contexts, contents, and gameplay. Moreover, these findings may also help healthcare professionals who concern stroke patient’s motivation in rehabilitative context. In this paper, we reported our Virtual Nursing Home (VNH concept and the games that we are currently developing and re-designing. Based on this literature review, we will present and test out the ideas how we can integrate these motivational factors in our future game design, development, and enhancement.

  8. The Erasmus Virtual Campus

    Science.gov (United States)

    Isakeit, D.

    2002-02-01

    The Erasmus Virtual Campus was inaugurated in September 2000 to bring together scientists and engineers interested in using the International Space Station and other facilities for their research. It also provides the foundation for creating Virtual Institutes in selected scientific disciplines. The current capabilities of the Campus are highlighted, along with plans for the future.

  9. Stroke Rehabilitation.

    Science.gov (United States)

    Belagaje, Samir R

    2017-02-01

    Rehabilitation is an important aspect of the continuum of care in stroke. With advances in the acute treatment of stroke, more patients will survive stroke with varying degrees of disability. Research in the past decade has expanded our understanding of the mechanisms underlying stroke recovery and has led to the development of new treatment modalities. This article reviews and summarizes the key concepts related to poststroke recovery. Good data now exist by which one can predict recovery, especially motor recovery, very soon after stroke onset. Recent trials have not demonstrated a clear benefit associated with very early initiation of rehabilitative therapy after stroke in terms of improvement in poststroke outcomes. However, growing evidence suggests that shorter and more frequent sessions of therapy can be safely started in the first 24 to 48 hours after a stroke. The optimal amount or dose of therapy for stroke remains undetermined, as more intensive treatments have not been associated with better outcomes compared to standard intensities of therapy. Poststroke depression adversely affects recovery across a variety of measures and is an important target for therapy. Additionally, the use of selective serotonin reuptake inhibitors (SSRIs) appears to benefit motor recovery through pleiotropic mechanisms beyond their antidepressant effect. Other pharmacologic approaches also appear to have a benefit in stroke rehabilitation. A comprehensive rehabilitation program is essential to optimize poststroke outcomes. Rehabilitation is a process that uses three major principles of recovery: adaptation, restitution, and neuroplasticity. Based on these principles, multiple different approaches, both pharmacologic and nonpharmacologic, exist to enhance rehabilitation. In addition to neurologists, a variety of health care professionals are involved in stroke rehabilitation. Successful rehabilitation involves understanding the natural history of stroke recovery and a

  10. Burden of stroke in Cambodia.

    Science.gov (United States)

    Loo, Keat Wei; Gan, Siew Hua

    2013-08-01

    In Cambodia, stroke is not ranked among the top 10 leading causes of death, but infectious disease are among the top three leading causes of death. This finding could be attributed to a lack of awareness among Cambodians of the signs and symptoms of stroke or to poor reporting, incomplete data, lack of neurologists and neurosurgeons, or low accessibility to the hospitals. The only study of stroke in Cambodia is the Prevalence of Non-Communicable Disease Risk Factors in Cambodia survey, which identified several stroke-related risk factors in the population. Tobacco chewing or smoking is the main risk factor for stroke in Cambodia. Traditional therapies, such as oyt pleung (moxibustion) and jup (cupping), are widely practiced for stroke rehabilitation. In Cambodia, there are few neurologists and few important equipment, such as magnetic resonance imaging machines and computed tomography scanners. The Cambodian government should cooperate with the World Health Organization and the United Nations Children's Fund to attract foreign expertise and technologies to treat stroke patients. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

  11. The Riks-Stroke story: building a sustainable national register for quality assessment of stroke care.

    Science.gov (United States)

    Asplund, Kjell; Hulter Åsberg, Kerstin; Appelros, Peter; Bjarne, Daniela; Eriksson, Marie; Johansson, Asa; Jonsson, Fredrik; Norrving, Bo; Stegmayr, Birgitta; Terént, Andreas; Wallin, Sari; Wester, Per-Olov

    2011-04-01

    Riks-Stroke, the Swedish Stroke Register, is the world's longest-running national stroke quality register (established in 1994) and includes all 76 hospitals in Sweden admitting acute stroke patients. The development and maintenance of this sustainable national register is described. Riks-Stroke includes information on the quality of care during the acute phase, rehabilitation and secondary prevention of stroke, as well as data on community support. Riks-Stroke is unique among stroke quality registers in that patients are followed during the first year after stroke. The data collected describe processes, and medical and patient-reported outcome measurements. The register embraces most of the dimensions of health-care quality (evidence-based, safe, provided in time, distributed fairly and patient oriented). Annually, approximately 25,000 patients are included. In 2009, approximately 320,000 patients had been accumulated (mean age 76-years). The register is estimated to cover 82% of all stroke patients treated in Swedish hospitals. Among critical issues when building a national stroke quality register, the delicate balance between simplicity and comprehensiveness is emphasised. Future developments include direct transfer of data from digital medical records to Riks-Stroke and comprehensive strategies to use the information collected to rapidly implement new evidence-based techniques and to eliminate outdated methods in stroke care. It is possible to establish a sustainable quality register for stroke at the national level covering all hospitals admitting acute stroke patients. Riks-Stroke is fulfilling its main goals to support continuous quality improvement of Swedish stroke services and serve as an instrument for following up national stroke guidelines. © 2010 The Authors. International Journal of Stroke © 2010 World Stroke Organization.

  12. Virtual colonoscopy

    Science.gov (United States)

    Colonoscopy - virtual; CT colonography; Computed tomographic colonography; Colography - virtual ... Differences between virtual and conventional colonoscopy include: VC can view the colon from many different angles. This is not as easy ...

  13. Quality of stroke care at an Irish Regional General Hospital and Stroke Rehabilitation Unit.

    LENUS (Irish Health Repository)

    Walsh, T

    2012-01-31

    BACKGROUND: Robust international data support the effectiveness of stroke unit (SU) care. Despite this, most stroke care in Ireland are provided outside of this setting. Limited data currently exist on the quality of care provided. AIM: The aim of this study is to examine the quality of care for patients with stroke in two care settings-Regional General Hospital (RGH) and Stroke Rehabilitation Unit (SRU). METHODS: A retrospective analysis of the stroke records of consecutive patients admitted to the SRU between May-November 2002 and April-November 2004 was performed applying the UK National Sentinel Audit of Stroke (NSAS) tool. RESULTS: The results of the study reveal that while SRU processes of care was 74% compliant with standards; compliance with stroke service organisational standards was only 15 and 43% in the RGH and SRU, respectively. CONCLUSION: The quality of stroke care in our area is deficient. Comprehensive reorganisation of stroke services is imperative.

  14. Searching for the Smoker's Paradox in Acute Stroke Patients Treated With Intravenous Thrombolysis.

    Science.gov (United States)

    Hussein, Haitham M; Niemann, Nicki; Parker, Emily D; Qureshi, Adnan I

    2017-07-01

    Inconsistent evidence supports better outcome in smokers after stroke. Our study examines this association in a large sample of ischemic stroke treated with intravenous thrombolysis. Virtual International Stroke Trials Archive (VISTA) database, composed of individual patient data of multiple clinical trials, was queried. The primary outcome was functional independence at 3 months noted by modified Rankin Scale (mRS; a 7-point scale ranging from 0 [no deficit] to 6 [death]) score≤ 2. The secondary outcomes were National Institutes of Health Stroke Scale (NIHSS; stroke severity measure, ranging from 0 [no deficit] to 42 [most severe]) score at 24 hours and the occurrence of symptomatic intractracranial hemorrhage. A total of 5383 patients were included: 1501 current smokers and 3882 nonsmokers. Smokers were younger (60 ± 13 vs. 71 ± 12 years, p vs. 13 [9-18], p smokers (49.7% vs. 39.5%, p non-significant after adjusting for age (OR 1.11, 95% CI 0.97-1.27). Subgroup analysis by age/gender strata showed that current smoking was associated with favorable outcome only in women ≥ 65 years. Current smoking was also associated with lower rates of symptomatic intracranial hemorrhage (adjusted OR 0.55, 95% CI 0.39-0.79). Smokers experience their first ever stroke 11 years younger than nonsmokers. This age difference explains the association between current smoking and favorable functional outcome. Smoking is associated with occurrence of first ever stroke at a younger age, therefore, focus should be on smoking prevention and treatment. The decision to treat ischemic stroke patients with intravenous thrombolysis should not be influenced by the patients' smoking status. © The Author 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  15. Developing multimedia software and virtual reality worlds and their use in rehabilitation and psychology.

    Science.gov (United States)

    Sik Lányi, Cecília; Laky, Viktória; Tilinger, Adám; Pataky, Ilona; Simon, Lajos; Kiss, Bernadett; Simon, Viktória; Szabó, Júlianna; Páll, Attila

    2004-01-01

    The multimedia and virtual reality projects performed at our laboratory during the last ten years can be grouped into the following groups: 1) tutorial and entertainment programs for handicapped children, 2) rehabilitation programs for stroke patients and patients with phobias. We have developed multimedia software for handicapped children with various impairments: partial vision, hearing difficulties, locomotive difficulties, mental retardation, dyslexia etc. In the present paper we show the advantages of using multimedia software to develop mental skills in handicapped people and deal with the special needs of handicapped children. For the rehabilitation of stroke patients we have developed a computer-controlled method, which enables - contrary to methods used internationally - not only the establishment of a diagnosis, but also measurement of therapy effectiveness: 1) it enables us to produce a database of patients, which contains not only their personal data but also test results, their drawings and audio recordings, 2) it is in itself an intensive therapeutic test and contains tutorial programs. We are currently collecting test results. We have also developed some virtual worlds for treating phobias: a virtual balcony and a ten-story building with an external glass elevator as well as an internal glass elevator in the virtual Atrium Hyatt hotel. We have developed a virtual environment for treating claustrophobia too: a closed lift and a room where the walls can move. For specific phobias (fear of travelling) we have modelled the underground railway system in Budapest. For autistic children, we have developed virtual shopping software too. In this paper we present the advantages of virtual reality in the investigation, evaluation and treatment of perception, behaviour and neuropsychological disorders.

  16. Stroke Care 2: Stroke rehabilitation

    NARCIS (Netherlands)

    Langhorne, P.; Bernhardt, J.; Kwakkel, G.

    2011-01-01

    Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially

  17. History of Virtual Water , International Trade and Economic Metabolism at the Time Colonialism and a First Attempt to Assess Their Impact on Hydrologic Changes

    Science.gov (United States)

    Greco, F.

    2008-12-01

    This research considers the historical impact of virtual water into the geophysical arena by considering it as a human-led phenomenon that impacts the hydrologic system and, consequently, the environment as a whole. This paper is in line with the idea of including the humans into the water-balance model, and it is deepening the idea that this has to be done not only at the light of each watershed, but globally, looking at the role of water-trade embedded in food and tradable goods. Starting from a definition of what virtual water is, this research explores the role of crops export in the early U.S. Colonial time. As early as 1630 a huge biomass from here was already exported to the UK (the fur trade). In 1700 the tobacco export started, along with cereals exports and timber. An entire ecosystem has been "exported" in terms of water-embedded-in-goods. This was the beginning of a massive depletion of bio-mass stocks and flows, a raise in nitrogen discharge into the environment and its impact on the hydrological systems ( CUAHSI Summer Institute findings). Immigration and its effects on the water balance is also considered in this work. The experiment of interdisciplinary work of CUAHSI Summer Institute 2008 has proven that there is space for a historical reconstruction of evidence of human-led changes to the hydrological systems. This has been possible through the analysis of material stocks and flows, water-balance analysis of these stocks and flows, including human-led changes like international trade and population growth. This proposal will argue that these changes can also be identified by the term of 'socio- economic metabolism', in which societies are trading their goods internationally but taking the primary resources, including water, locally. This work will put the basis for the history of virtual water and its implications on both socio-economic metabolism and local geophysical changes.

  18. Preventing stroke

    Science.gov (United States)

    ... with which you were born Changes to your lifestyle You can change some risk factors for stroke, ... sodium (salt). Read labels and stay away from unhealthy fats. Avoid foods with: Saturated fat Partially-hydrogenated ...

  19. Stroke Rehabilitation

    Science.gov (United States)

    ... of the effects of a stroke Trouble swallowing (dysphagia) Problems with bowel or bladder control Fatigue Difficulty ... NINDS Focus on Disorders Alzheimer's & Related Dementias Epilepsy Parkinson's Disease Spinal Cord Injury Traumatic Brain Injury Focus ...

  20. Pediatric stroke

    International Nuclear Information System (INIS)

    Hoermann, M.

    2008-01-01

    Stroke in childhood has gained increasingly more attention and is accepted as an important disease in childhood. The reasons for this severe event and the consequences for the rest of the life are totally different than for adults. This is also true for the diagnosis and therapy. This paper gives a comprehensive overview on the characteristics of pediatric stroke to assist radiologists in making a rapid and safe diagnosis in order to identify the underlying disease. (orig.) [de

  1. Dissection of the internal carotid artery and stroke after mandibular fractures: a case report and review of the literature

    OpenAIRE

    Tveita, Ingrid Aune; Madsen, Martin Ragnar Skjerve; Nielsen, Erik Waage

    2017-01-01

    Source at https://doi.org/10.1186/s13256-017-1316-1 Background: We present a report of a patient with blunt trauma and mandibular fractures who developed a significant cerebral infarction due to an initially unrecognized injury of her left internal carotid artery. We believe that increased knowledge of this association will facilitate early recognition and hence prevention of a devastating outcome. Case presentation: A 41-year-old ethnic Norwegian woman presented to our Emerg...

  2. Multisensory stimulation in stroke rehabilitation

    Directory of Open Access Journals (Sweden)

    Barbro Birgitta Johansson

    2012-04-01

    Full Text Available The brain has a large capacity for automatic simultaneous processing and integration of sensory information. Combining information from different sensory modalities facilitates our ability to detect, discriminate, and recognize sensory stimuli, and learning is often optimal in a multisensory environment. Currently used multisensory stimulation methods in stroke rehabilitation include motor imagery, action observation, training with a mirror or in a virtual environment, or various kinds of music therapy. Several studies have shown positive effects been reported but to give general recommendation more studies are needed. Patient heterogeneity and the interactions of age, gender, genes and environment are discussed. Randomized controlled longitudinal trials starting earlier post stroke are needed. The advance in brain network science and neuroimaging enabling longitudinal studies of structural and functional networks are likely to have an important impact on patient selection for specific interventions in future stroke rehabilitation.

  3. Dissection of the internal carotid artery and stroke after mandibular fractures: a case report and review of the literature.

    Science.gov (United States)

    Tveita, Ingrid Aune; Madsen, Martin Ragnar Skjerve; Nielsen, Erik Waage

    2017-06-02

    We present a report of a patient with blunt trauma and mandibular fractures who developed a significant cerebral infarction due to an initially unrecognized injury of her left internal carotid artery. We believe that increased knowledge of this association will facilitate early recognition and hence prevention of a devastating outcome. A 41-year-old ethnic Norwegian woman presented to our Emergency Room after a bicycle accident that had caused a direct blow to her chin. At admittance, her Glasgow Coma Scale was 15. Initial trauma computed tomography showed triple fractures of her mandible, but no further pathology. She was placed in our Intensive Care Unit awaiting open reduction of her mandibular fractures. During the following 9 hours, she showed recurrent episodes of confusion and a progressive right-sided hemiparesis. Repeated cerebral computed tomography revealed no further pathology compared to the initial scan. She had magnetic resonance angiography 17 hours after admittance, which showed dissection and thrombus formation in her left internal carotid artery, total occlusion of her left medial cerebral artery, and left middle cerebral artery infarction was detected. Carotid artery dissection is a rare but life-threatening condition that can develop after trauma to the head and neck. There should be a high index of suspicion in patients with a mechanism of injury that places the internal carotid artery at risk because blunt vascular injury may show delayed onset with no initial symptoms of vascular damage. By implementing an algorithm for early detection and treatment of these injuries, serious brain damage may be avoided.

  4. Atherosclerosis and Stroke

    Science.gov (United States)

    ... Stroke Association.org Professionals for Stroke Association.org Shop for Stroke Association.org Support for Stroke Association. ... endothelium significantly. The artery’s diameter shrinks and blood flow decreases, reducing oxygen supply. How atherosclerotic plaque causes ...

  5. Early tracheostomy in ventilated stroke patients: Study protocol of the international multicentre randomized trial SETPOINT2 (Stroke-related Early Tracheostomy vs. Prolonged Orotracheal Intubation in Neurocritical care Trial 2).

    Science.gov (United States)

    Schönenberger, Silvia; Niesen, Wolf-Dirk; Fuhrer, Hannah; Bauza, Colleen; Klose, Christina; Kieser, Meinhard; Suarez, José I; Seder, David B; Bösel, Julian

    2016-04-01

    Tracheostomy is a common procedure in long-term ventilated critical care patients and frequently necessary in those with severe stroke. The optimal timing for tracheostomy is still unknown, and it is controversial whether early tracheostomy impacts upon functional outcome. The Stroke-related Early Tracheostomy vs. Prolonged Orotracheal Intubation in Neurocritical care Trial 2 (SETPOINT2) is a multicentre, prospective, randomized, open-blinded endpoint (PROBE-design) trial. Patients with acute ischemic stroke, intracerebral hemorrhage or subarachnoid hemorrhage who are so severely affected that two weeks of ventilation are presumed necessary based on a prediction score are eligible. It is intended to enroll 190 patients per group (n = 380). Patients are randomized to either percutaneous tracheostomy within the first five days after intubation or to ongoing orotracheal intubation with consecutive weaning and extubation and, if the latter failed, to percutaneous tracheostomy from day 10 after intubation. The primary endpoint is functional outcome defined by the modified Rankin Scale (mRS, 0-4 (favorable) vs. 5 + 6 (unfavorable)) after six months; secondary endpoints are mortality and cause of mortality during intensive care unit-stay and within six months from admission, intensive care unit-length of stay, duration of sedation, duration of ventilation and weaning, timing and reasons for withdrawal of life support measures, relevant intracranial pressure rises before and after tracheostomy. The necessity and optimal timing of tracheostomy in ventilated stroke patients need to be identified. SETPOINT2 should clarify whether benefits in functional outcome can be achieved by early tracheostomy in these patients. © 2016 World Stroke Organization.

  6. Heat Stroke

    DEFF Research Database (Denmark)

    Mørch, Sofie Søndergaard; Andersen, Johnny Dohn Holmgren; Bestle, Morten Heiberg

    2017-01-01

    not diagnosed until several days after admittance; hence treatment with cooling was delayed. Both patients were admitted to the intensive care unit, where they were treated with an external cooling device and received treatment for complications. Both cases ended fatally. As global warming continues, more heat......Heat stroke is an acute, life-threatening emergency characterized clinically by elevated body temperature and central nervous system dysfunction. Early recognition and treatment including aggressive cooling and management of life-threatening systemic complications are essential to reduce morbidity...... and mortality. This case report describes two Danish patients diagnosed with heat stroke syndrome during a heat wave in the summer of 2014. Both patients were morbidly obese and had several predisposing illnesses. However since heat stroke is a rare condition in areas with temperate climate, they were...

  7. Association between Champagne Bottle Neck Sign of Internal Carotid Artery and Ipsilateral Hemorrhagic Stroke in Patients with Moyamoya Disease.

    Science.gov (United States)

    Wang, Jian; Chen, Gong; Yang, Yongbo; Zhang, Bing; Jia, Zhongzhi; Gu, Peiyuan; Wei, Dong; Ji, Jing; Hu, Weixing; Zhao, Xihai

    2018-06-15

    To assess the association between champagne bottle neck sign (CBNS) in carotid artery and intracranial hemorrhage in patients with moyamoya disease (MMD). From January 2016 to December 2017, a total of 76 consecutive patients with MMD without definite risk factors associated intracranial hemorrhage who underwent preoperative angiography were included in this retrospective study. CBNS was defined as luminal diameter of internal carotid artery (ICA)/common carotid artery (CCA) ≤ 0.5 on angiographic imaging. The right and left cerebral hemisphere in each patient was separately identified as hemorrhagic and none-hemorrhagic. The association between CBNS and intracranial hemorrhage was analyzed. Of 76 MMD patients, intracranial hemorrhage was found in 44 (28.9%) hemispheres of 152 and 6.8% (3/44) had multiple events. Compared carotid arteries without intracranial hemorrhage in the ipsilateral hemispheres, those with intracranial hemorrhage in the ipsilateral hemispheres had significantly smaller luminal diameter ratio of ICA/CCA (0.49 ± 0.11 vs. 0.55 ± 0.12, p < 0.01) and higher prevalence of CBNS (63.7% vs. 41.7%, p = 0.01). For hemispheres with intracranial hemorrhage, those with ipsilateral carotid artery CBNS had significantly higher prevalence of hemorrhage at posterior territories than those without (57.1% vs. 23.1%, p=0.05). Logistic regression revealed that CBNS was significantly associated with ipsilateral intracranial hemorrhage before (OR, 2.45; 95% CI, 1.19-5.05; p=0.02) and after (OR, 3.43; 95% CI, 1.50-7.87; p<0.01) adjusted for female, lenticulostriate anastomosis, and choroidal anastomosis. CBNS is significantly associated with intracranial hemorrhage at ipsilateral hemisphere in MMD patients, particularly for intracranial hemorrhage at posterior territories. Copyright © 2018. Published by Elsevier Inc.

  8. Aphasia As a Predictor of Stroke Outcome.

    Science.gov (United States)

    Lazar, Ronald M; Boehme, Amelia K

    2017-09-19

    Aphasia is a common feature of stroke, affecting 21-38% of acute stroke patients and an estimated 1 million stroke survivors. Although stroke, as a syndrome, is the leading cause of disability in the USA, less is known about the independent impact of aphasia on stroke outcomes. During the acute stroke period, aphasia has been found to increase length of stay, inpatient complications, overall neurological disability, mortality, and to alter discharge disposition. Outcomes during the sub-acute and chronic stroke periods show that aphasia is associated with lower Functional Independence Measures (FIM) scores, longer stays in rehabilitation settings, poorer function in activities of daily living, and mortality. Factors that complicate the analysis of aphasia on post-stroke outcomes, however, include widely different systems of care across international settings that result in varying admission patterns to acute stroke units, allowable length of stays based on reimbursement, and criteria for rehabilitation placement. Aphasia arising from stroke is associated with worse outcomes both in the acute and chronic periods. Future research will have to incorporate disparate patterns in analytic models, and to take into account specific aphasia profiles and evolving methods of post-stroke speech-language therapy.

  9. Virtual Reality

    Science.gov (United States)

    1993-04-01

    until exhausted. SECURITY CLASSIFICATION OF THIS PAGE All other editions are obsolete. UNCLASSIFIED " VIRTUAL REALITY JAMES F. DAILEY, LIEUTENANT COLONEL...US" This paper reviews the exciting field of virtual reality . The author describes the basic concepts of virtual reality and finds that its numerous...potential benefits to society could revolutionize everyday life. The various components that make up a virtual reality system are described in detail

  10. Virtual Box

    DEFF Research Database (Denmark)

    Davis, Hilary; Skov, Mikael B.; Stougaard, Malthe

    2007-01-01

    . This paper reports on the design, implementation and initial evaluation of Virtual Box. Virtual Box attempts to create a physical and engaging context in order to support reciprocal interactions with expressive content. An implemented version of Virtual Box is evaluated in a location-aware environment...

  11. Wireless virtualization

    CERN Document Server

    Wen, Heming; Le-Ngoc, Tho

    2013-01-01

    This SpringerBriefs is an overview of the emerging field of wireless access and mobile network virtualization. It provides a clear and relevant picture of the current virtualization trends in wireless technologies by summarizing and comparing different architectures, techniques and technologies applicable to a future virtualized wireless network infrastructure. The readers are exposed to a short walkthrough of the future Internet initiative and network virtualization technologies in order to understand the potential role of wireless virtualization in the broader context of next-generation ubiq

  12. Virtual marketing in virtual enterprises

    OpenAIRE

    Ale Ebrahim, Nader; Fattahi, Hamaid Ali; Golnam, Arash

    2008-01-01

    Virtualization caused tremendous evolution in the economics of marketing channels, patterns of physical distribution and the structure of distributors and developed a new concept that is known as virtual marketing (VM). VM combines the powerful technologies of interactive marketing and virtual reality. Virtual enterprise (VE) refers to an organization not having a clear physical locus. In other words, VE is an organization distributed geographically and whose work is coordinated through e...

  13. Solid-solid phase transformation via internal stress-induced virtual melting, significantly below the melting temperature. Application to HMX energetic crystal.

    Science.gov (United States)

    Levitas, Valery I; Henson, Bryan F; Smilowitz, Laura B; Asay, Blaine W

    2006-05-25

    We theoretically predict a new phenomenon, namely, that a solid-solid phase transformation (PT) with a large transformation strain can occur via internal stress-induced virtual melting along the interface at temperatures significantly (more than 100 K) below the melting temperature. We show that the energy of elastic stresses, induced by transformation strain, increases the driving force for melting and reduces the melting temperature. Immediately after melting, stresses relax and the unstable melt solidifies. Fast solidification in a thin layer leads to nanoscale cracking which does not affect the thermodynamics or kinetics of the solid-solid transformation. Thus, virtual melting represents a new mechanism of solid-solid PT, stress relaxation, and loss of coherence at a moving solid-solid interface. It also removes the athermal interface friction and deletes the thermomechanical memory of preceding cycles of the direct-reverse transformation. It is also found that nonhydrostatic compressive internal stresses promote melting in contrast to hydrostatic pressure. Sixteen theoretical predictions are in qualitative and quantitative agreement with experiments conducted on the PTs in the energetic crystal HMX. In particular, (a) the energy of internal stresses is sufficient to reduce the melting temperature from 551 to 430 K for the delta phase during the beta --> delta PT and from 520 to 400 K for the beta phase during the delta --> beta PT; (b) predicted activation energies for direct and reverse PTs coincide with corresponding melting energies of the beta and delta phases and with the experimental values; (c) the temperature dependence of the rate constant is determined by the heat of fusion, for both direct and reverse PTs; results b and c are obtained both for overall kinetics and for interface propagation; (d) considerable nanocracking, homogeneously distributed in the transformed material, accompanies the PT, as predicted by theory; (e) the nanocracking does not

  14. Strategies for stroke rehabilitation.

    Science.gov (United States)

    Dobkin, Bruce H

    2004-09-01

    Rehabilitation after hemiplegic stroke has typically relied on the training of patients in compensatory strategies. The translation of neuroscientific research into care has led to new approaches and renewed promise for better outcomes. Improved motor control can progress with task-specific training incorporating increased use of proximal and distal movements during intensive practice of real-world activities. Functional gains are incorrectly said to plateau by 3-6 months. Many patients retain latent sensorimotor function that can be realised any time after stroke with a pulse of goal-directed therapy. The amount of practice probably best determines gains for a given level of residual movement ability. Clinicians should encourage patients to build greater strength, speed, endurance, and precision of multijoint movements on tasks that increase independence and enrich daily activity. Imaging tools may help clinicians determine the capacity of residual networks to respond to a therapeutic approach and help establish optimal dose-response curves for training. Promising adjunct approaches include practice with robotic devices or in a virtual environment, electrical stimulation to increase cortical excitability during training, and drugs to optimise molecular mechanisms for learning. Biological strategies for neural repair may augment rehabilitation in the next decade.

  15. Virtual TeleRehab: a case study.

    Science.gov (United States)

    Pareto, Lena; Johansson, Britt; Zeller, Sally; Sunnerhagen, Katharina S; Rydmark, Martin; Broeren, Jurgen

    2011-01-01

    We examined the efficacy of a remotely based occupational therapy intervention. A 40-year-old woman who suffered a stroke participated in a telerehabilitation program. The intervention method is based on virtual reality gaming to enhance the training experience and to facilitate the relearning processes. The results indicate that Virtual TeleRehab is an effective method for motivational, economical, and practical reasons by combining game-based rehabilitation in the home with weekly distance meetings.

  16. Facilitating Stroke Management using Modern Information Technology.

    Science.gov (United States)

    Nam, Hyo Suk; Park, Eunjeong; Heo, Ji Hoe

    2013-09-01

    Information technology and mobile devices may be beneficial and useful in many aspects of stroke management, including recognition of stroke, transport and triage of patients, emergent stroke evaluation at the hospital, and rehabilitation. In this review, we address the contributions of information technology and mobile health to stroke management. Rapid detection and triage are essential for effective thrombolytic treatment. Awareness of stroke warning signs and responses to stroke could be enhanced by using mobile applications. Furthermore, prehospital assessment and notification could be streamlined for use in telemedicine and teleradiology. A mobile telemedicine system for assessing the National Institutes of Health Stroke Scale scores has shown higher correlation and fast assessment comparing with face-to-face method. Because the benefits of thrombolytic treatment are time-dependent, treatment should be initiated as quickly as possible. In-hospital communication between multidisciplinary team members can be enhanced using information technology. A computerized in-hospital alert system using computerized physician-order entry was shown to be effective in reducing the time intervals from hospital arrival to medical evaluations and thrombolytic treatment. Mobile devices can also be used as supplementary tools for neurologic examination and clinical decision-making. In post-stroke rehabilitation, virtual reality and telerehabilitation are helpful. Mobile applications might be useful for public awareness, lifestyle modification, and education/training of healthcare professionals. Information technology and mobile health are useful tools for management of stroke patients from the acute period to rehabilitation. Further improvement of technology will change and enhance stroke prevention and treatment.

  17. Virtual Exploratories

    DEFF Research Database (Denmark)

    Jensen, Sisse Siggaard

    2006-01-01

    -systems, the paper introduces the designing strategy referred to as virtual exploratories. Some of the advanced virtual worlds may inspire the design of such provoking and challenging virtual exploratories, and especially the Massively Multi-User Online Role-Playing Games (MMORPGS). However, if we have to learn from...... the design and activity of the advanced virtual worlds and role-playing games, then the empirical research on the actors’ activity, while they are acting, is an important precondition to it. A step towards the conception of such a designing strategy for virtual exploratories is currently pursued....... [1] The research project: Actors and Avatars Communicating in Virtual Worlds – an Empirical Analysis of Actors’ Sense-making Strategies When Based on a Communication Theoretical Approach’ (2006-2007) is supported...

  18. Virtual Reflexes

    OpenAIRE

    Jonker, Catholijn; Broekens, Joost; Plaat, Aske

    2014-01-01

    Virtual Reality is used successfully to treat people for regular phobias. A new challenge is to develop Virtual Reality Exposure Training for social skills. Virtual actors in such systems have to show appropriate social behavior including emotions, gaze, and keeping distance. The behavior must be realistic and real-time. Current approaches consist of four steps: 1) trainee social signal detection, 2) cognitive-affective interpretation, 3) determination of the appropriate bodily responses, and...

  19. Virtual volatility

    Science.gov (United States)

    Silva, A. Christian; Prange, Richard E.

    2007-03-01

    We introduce the concept of virtual volatility. This simple but new measure shows how to quantify the uncertainty in the forecast of the drift component of a random walk. The virtual volatility also is a useful tool in understanding the stochastic process for a given portfolio. In particular, and as an example, we were able to identify mean reversion effect in our portfolio. Finally, we briefly discuss the potential practical effect of the virtual volatility on an investor asset allocation strategy.

  20. Virtual bronchoscopy

    International Nuclear Information System (INIS)

    Rogalla, P.; Meiri, N.; Hamm, B.; Rueckert, J.C.; Schmidt, B.; Witt, C.

    2001-01-01

    Flexible bronchoscopy represents a clinically well-established invasive diagnostic tool. Virtual bronchoscopies, calculated from thin-slice CT sections, allow astonishing immitations of reality although principal differences exist between both technologies: the Fact that colour representation is artificial and concommitant interventions are impossible limits the clinical use of virtual bronchoscopy. However, its value increases when calculations can be attained within minutes due to technological advancements, and when virtually any chest CT is suitable for further postprocessing. Indications, findings and the clinical role of virtual bronchoscopy are discussed. (orig.) [de

  1. Virtual projects

    DEFF Research Database (Denmark)

    Svejvig, Per; Commisso, Trine Hald

    2012-01-01

    that the best practice knowledge has not permeated sufficiently to the practice. Furthermore, the appropriate application of information and communication technology (ICT) remains a big challenge, and finally project managers are not sufficiently trained in organizing and conducting virtual projects....... The overall implications for research and practice are to acknowledge virtual project management as very different to traditional project management and to address this difference.......Virtual projects are common with global competition, market development, and not least the financial crisis forcing organizations to reduce their costs drastically. Organizations therefore have to place high importance on ways to carry out virtual projects and consider appropriate practices...

  2. Risk profiles and antithrombotic treatment of patients newly diagnosed with atrial fibrillation at risk of stroke: perspectives from the international, observational, prospective GARFIELD registry

    NARCIS (Netherlands)

    Kakkar, A.K.; Mueller, I.; Bassand, J.P.; Fitzmaurice, D.A.; Goldhaber, S.Z.; Goto, S.; Haas, S.; Hacke, W.; Lip, G.Y.; Mantovani, L.G.; Turpie, A.G.G.; Eickels, M. van; Misselwitz, F.; Rushton-Smith, S.; Kayani, G.; Wilkinson, P.; Verheugt, F.W.A.; et al.,

    2013-01-01

    BACKGROUND: Limited data are available on the characteristics, clinical management, and outcomes of patients with atrial fibrillation at risk of stroke, from a worldwide perspective. The aim of this study was to describe the baseline characteristics and initial therapeutic management of patients

  3. Stroke patients' experiences with Wii Sports® during inpatient rehabilitation

    DEFF Research Database (Denmark)

    Celinder, Dora; Peoples, Hanne

    2012-01-01

    INTRODUCTION: Commercial virtual reality games have been used as adjunct therapy for stroke rehabilitation, mainly after patients have been discharged. The aim of this study was to explore stroke patients' experiences with Wii Sports® as a supplement to conventional occupational therapy in a cont......INTRODUCTION: Commercial virtual reality games have been used as adjunct therapy for stroke rehabilitation, mainly after patients have been discharged. The aim of this study was to explore stroke patients' experiences with Wii Sports® as a supplement to conventional occupational therapy...... therapy services may benefit patient rehabilitation directly or provide motivation for alternative leisure activities....

  4. Virtual Environments 2005

    DEFF Research Database (Denmark)

    This book contains the proceedings of the joint 9th International Immersive Projection Technologies Workshop and the 11th EUROGRAPHICS Virtual Environments Workshop (IPTEGVE). The event was held in Aalborg, Denmark the 6. and 7. October 2005. It was organized at the VR Media Lab, Aalborg University...

  5. Stroke prevention in atrial fibrillation: findings from Tuscan FADOI Stroke Registry

    Directory of Open Access Journals (Sweden)

    Luca Masotti

    2014-06-01

    Full Text Available Despite vitamin K antagonists (VKAs are considered the first choice treatment for stroke prevention in atrial fibrillation (AF, literature shows their underuse in this context. Since data about VKAs use prior and after acute stroke lack, the aim of this study was to focus on management of anticoagulation with VKAs in this context. Data were retrieved from Tuscan FADOI Stroke Registry, an online data bank aimed to report on characteristics of stroke patients consecutively admitted in Internal Medicine wards in 2010 and 2011. In this period 819 patients with mean age 76.5±12.3 years were enrolled. Data on etiology were available for 715 of them (88.1%, 87% being ischemic and 13% hemorrhagic strokes. AF was present in 238 patients (33%, 165 (69.3% having a known AF before hospitalization, whereas 73 patients (31.7% received a new diagnosis of AF. A percentage of 89% of strokes in patients with known AF were ischemic and 11% hemorrhagic. A percentage of 86.7% of patients with known AF had a CHADS2 ≥2, but only 28.3% were on VKAs before hospitalization. A percentage of 78.8% of patients treated with VKAs before stroke had an international normalized ratio (INR ≤2.0; 68.7% of patients with VKAs-related hemorrhagic strokes had INR ≤3.0. Combined endpoint mortality or severe disability in patients with ischemic stroke associated with AF was present in 47%, while it was present in 19.30% and 19.20% of atherothrombotic and lacunar strokes, respectively. At hospital discharge, VKAs were prescribed in 25.9% of AF related ischemic stroke patients. AF related strokes are burdened by severe outcome but VKAs are dramatically underused in patients with AF, even in higher risk patients. Efforts to improve anticoagulation in this stroke subtype are warranted.

  6. Prevention Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D

    2005-01-01

    Full Text Available Stroke is an important cause for neurological morbidity and mortality. Prevention of ischemic stroke involves identification and prevention of risk factors and optimal use of pharmacotherapy. Risk factors have been classified as modifiable and non-modifiable; control of modifiable factors should prevent stroke occurrence. Stroke prevention has been described at three levels: primary, secondary and tertiary. Prolonged hypertension increases an individual′s risk for developing fatal or nonfatal stroke by three times and its control has been shown to prevent stroke. Diabetes mellitus is an important cause for microangiopathy and predisposes to stroke. Statin trials have shown significant reduction in stroke in those who were treated with statins. Stroke risk can be reduced by avoiding tobacco use, control of obesity and avoiding sedentary life style. Anti platelet medications are effective for secondary prevention of stroke. Educating society regarding modifiable risk factors and optimal use of pharmacotherapy form the cornerstone for the prevention of stroke.

  7. Virtual Workshop

    DEFF Research Database (Denmark)

    Buus, Lillian; Bygholm, Ann

    In relation to the Tutor course in the Mediterranean Virtual University (MVU) project, a virtual workshop “Getting experiences with different synchronous communication media, collaboration, and group work” was held with all partner institutions in January 2006. More than 25 key-tutors within MVU...

  8. Ipsilateral hemiparesis in ischemic stroke patients.

    Science.gov (United States)

    Inatomi, Y; Nakajima, M; Yonehara, T; Ando, Y

    2017-07-01

    To investigate clinical characteristics of ipsilateral hemiparesis in ischemic stroke patients. Patients with acute ischemic stroke were prospectively examined. Ipsilateral hemiparesis was defined as hemiparesis ipsilateral to recent stroke lesions. Patients with ipsilateral hemiparesis were examined with functional neuroimaging studies including transcranial magnetic stimulation (TMS) and functional MRI. Of 8360 patients, ipsilateral hemiparesis was detected in 14 patients (0.17%, mean age 71±6 years, eight men). Lesions responsible for the recent strokes were located in the frontal cortex in three patients, corona radiata in seven, internal capsule in one, and pons in three. These lesions were located along the typical route of the corticospinal tract in all but one patient. Thirteen patients also had a past history of stroke contralateral to the recent lesions; 12 of these had motor deficits contralateral to past stroke lesions. During TMS, ipsilateral magnetic evoked potentials were evoked in two of seven patients and contralateral potentials were evoked in all seven. Functional MRI activated cerebral hemispheres ipsilaterally in eight of nine patients and contralaterally in all nine. Most patients with ipsilateral hemiparesis had a past history of stroke contralateral to the recent one, resulting in motor deficits contralateral to the earlier lesions. Moreover, functional neuroimaging findings indicated an active crossed corticospinal tract in all of the examined patients. Both findings suggest the contribution of the uncrossed corticospinal tract contralateral to stroke lesions as a post-stroke compensatory motor system. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. In-hospital stroke: characteristics and outcomes.

    LENUS (Irish Health Repository)

    Briggs, R

    2015-01-01

    In-hospital stroke (IS) made up 6.5% of strokes recorded in the Irish National Stroke Register in 2012. International research has demonstrated poorer outcomes post IS compared to out of hospital stroke (OS). We aimed to profile all IS and OS over a 22 month period and compare the two groups by gathering data from the HIPE portal stroke register. The study site is a primary stroke centre. IS represented 11% (50\\/458) of total strokes with over half (27\\/50, 54%) admitted initially with medical complaints. IS patients had a significantly longer length of stay (79.2 +\\/- 87.4 days vs. 21.9 +\\/- 45.9 days, p < 0.01) and higher mortality (13\\/50 vs. 39\\/408, p < 0.01). Patients in the IS group were also less likely to receive stroke unit care (1\\/50 vs. 136\\/408, p < 0.01). This study demonstrates the significant morbidity and mortality associated with IS and highlights the need for efforts to be made to optimize identification and management of acute stroke in this cohort.

  10. Construct validity of the items on the Stroke Specific Quality of Life (SS-QOL) questionnaire that evaluate the participation component of the International Classification of Functioning, Disability and Health.

    Science.gov (United States)

    Silva, Soraia Micaela; Corrêa, Fernanda Ishida; Pereira, Gabriela Santos; Faria, Christina Danielli Coelho de Morais; Corrêa, João Carlos Ferrari

    2018-01-01

    Analyze the construct validity and internal consistency of the Stroke Specific Quality of Life (SS-QOL) items that address the participation component of the ICF as well as analyze the ceiling and floor effects. One hundred subjects were analyzed: 85 community-dwelling and 15 institutionalized individuals. The analysis of construct validity was performed using classic psychometrics: (1) the comparison of known groups (individuals without restriction to participation vs. those with restriction to participation) using the Mann-Whitney test and (2) convergent validity - correlation between the scores on the SS-QOL items that address participation and the subscale scores of measures used to evaluate the similar constructs and concepts [the Short-Form Health Survey (SF-36), Functional Independence Measure (FIM) and grip strength test]. Spearman's correlation coefficients were calculated for this analysis. Cronbach's α was used for the analysis of internal consistency and both the ceiling and floor effects were analyzed. The level of significance for all analyses was α = 0.05. The a priori hypotheses regarding construct validity were partially demonstrated, as only five of the eight domains exhibited positive moderate to strong correlations (r > 0.40) with measures that address constructs similar to those addressed on the SS-QOL questionnaire. The items demonstrated adequate internal consistency and are capable of differentiating individuals with and without restriction to participation. The ceiling and floor effects were considered adequate for the total SS-QOL score, but beyond acceptable standards for some domains. The 26 items of the SS-QOL questionnaire measure a multidimensional construct and therefore do not only address participation. However, the items demonstrated adequate internal consistency and are capable of differentiating individuals with and without restriction to participation. Implications for rehabilitation The 26 items of the SS

  11. Driving After a Stroke

    Science.gov (United States)

    ... 23,2015 Can I drive after a stroke? Driving is often a major concern after someone has a stroke. It’s not unusual for stroke survivors to want to drive. Being able to get around after a stroke is important. Safety behind the wheel is even more important after ...

  12. Leukocytosis in acute stroke

    DEFF Research Database (Denmark)

    Kammersgaard, L P; Jørgensen, H S; Nakayama, H

    1999-01-01

    Leukocytosis is a common finding in the acute phase of stroke. A detrimental effect of leukocytosis on stroke outcome has been suggested, and trials aiming at reducing the leukocyte response in acute stroke are currently being conducted. However, the influence of leukocytosis on stroke outcome has...

  13. Virtual Teams.

    Science.gov (United States)

    Geber, Beverly

    1995-01-01

    Virtual work teams scattered around the globe are becoming a feature of corporate workplaces. Although most people prefer face-to-face meetings and interactions, reality often requires telecommuting. (JOW)

  14. Virtual data

    International Nuclear Information System (INIS)

    Bjorklund, E.

    1993-01-01

    In the 1970's, when computers were memory limited, operating system designers created the concept of ''virtual memory'' which gave users the ability to address more memory than physically existed. In the 1990s, many large control systems have the potential for becoming data limited. We propose that many of the principles behind virtual memory systems (working sets, locality, caching, and clustering) can also be applied to data-limited systems - creating, in effect, ''virtual data systems.'' At the Los Alamos National Laboratory's Clinton P. Anderson Meson Physics Facility (LAMPF), we have applied these principles to a moderately sized (10,000 data points) data acquisition and control system. To test the principles, we measured the system's performance during tune-up, production, and maintenance periods. In this paper, we present a general discussion of the principles of a virtual data system along with some discussion of our own implementation and the results of our performance measurements

  15. Virtual Worlds for Virtual Organizing

    Science.gov (United States)

    Rhoten, Diana; Lutters, Wayne

    The members and resources of a virtual organization are dispersed across time and space, yet they function as a coherent entity through the use of technologies, networks, and alliances. As virtual organizations proliferate and become increasingly important in society, many may exploit the technical architecture s of virtual worlds, which are the confluence of computer-mediated communication, telepresence, and virtual reality originally created for gaming. A brief socio-technical history describes their early origins and the waves of progress followed by stasis that brought us to the current period of renewed enthusiasm. Examination of contemporary examples demonstrates how three genres of virtual worlds have enabled new arenas for virtual organizing: developer-defined closed worlds, user-modifiable quasi-open worlds, and user-generated open worlds. Among expected future trends are an increase in collaboration born virtually rather than imported from existing organizations, a tension between high-fidelity recreations of the physical world and hyper-stylized imaginations of fantasy worlds, and the growth of specialized worlds optimized for particular sectors, companies, or cultures.

  16. Mid-cervical flame-shaped pseudo-occlusion: diagnostic performance of mid-cervical flame-shaped extracranial internal carotid artery sign on computed tomographic angiography in hyperacute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Prakkamakul, Supada; Pitakvej, Nantaporn [King Chulalongkorn Memorial Hospital the Thai Red Cross Society, Department of Radiology, Bangkok (Thailand); Dumrongpisutikul, Netsiri; Lerdlum, Sukalaya [King Chulalongkorn Memorial Hospital the Thai Red Cross Society, Department of Radiology, Bangkok (Thailand); Chulalongkorn University, Department of Radiology, Faculty of Medicine, Bangkok (Thailand)

    2017-10-15

    Flame-shaped pseudo-occlusion of the extracranial internal carotid artery (ICA) is a flow-related phenomenon that creates computed tomographic angiography (CTA) and digital subtraction angiography (DSA) findings that mimic tandem intracranial-extracranial ICA occlusion or dissection. We aim to determine the diagnostic performance of mid-cervical flame-shaped extracranial ICA sign on CTA in hyperacute ischemic stroke patients. We retrospectively included consecutive anterior circulation ischemic stroke patients presenting within 6 h of symptom onset who underwent 4D brain CTA and arterial-phase neck CTA using a 320-detector CT scanner during August 2012 to July 2015. Two blinded readers independently reviewed arterial-phase neck CTA and characterized the extracranial ICA configurations into mid-cervical flame-shaped, proximal blunt/beak-shaped, and tubular-shaped groups. 4D whole brain CTA was used as a reference standard for intracranial ICA occlusion detection. Diagnostic performance of the mid-cervical flame-shaped extracranial ICA sign and interobserver reliability were calculated. Of the 81 cases, 11 had isolated intracranial ICA occlusion, and 6 had true extracranial ICA occlusion. Mid-cervical flame-shaped extracranial ICA sign was found in 45.5% (5/11) of isolated intracranial ICA occlusions but none in the true extracranial ICA occlusion group. The sensitivity, specificity, PPV, NPV, and accuracy of the mid-cervical flame-shaped extracranial ICA sign for the detection of isolated intracranial ICA occlusion were 45.5, 100, 100, 92.1, and 92.6%, respectively. Interobserver reliability was 0.90. The mid-cervical flame-shaped extracranial ICA sign may suggest the presence of isolated intracranial ICA occlusion and allow reliable exclusion of tandem extracranial-intracranial ICA occlusion in hyperacute ischemic stroke setting. (orig.)

  17. Mid-cervical flame-shaped pseudo-occlusion: diagnostic performance of mid-cervical flame-shaped extracranial internal carotid artery sign on computed tomographic angiography in hyperacute ischemic stroke

    International Nuclear Information System (INIS)

    Prakkamakul, Supada; Pitakvej, Nantaporn; Dumrongpisutikul, Netsiri; Lerdlum, Sukalaya

    2017-01-01

    Flame-shaped pseudo-occlusion of the extracranial internal carotid artery (ICA) is a flow-related phenomenon that creates computed tomographic angiography (CTA) and digital subtraction angiography (DSA) findings that mimic tandem intracranial-extracranial ICA occlusion or dissection. We aim to determine the diagnostic performance of mid-cervical flame-shaped extracranial ICA sign on CTA in hyperacute ischemic stroke patients. We retrospectively included consecutive anterior circulation ischemic stroke patients presenting within 6 h of symptom onset who underwent 4D brain CTA and arterial-phase neck CTA using a 320-detector CT scanner during August 2012 to July 2015. Two blinded readers independently reviewed arterial-phase neck CTA and characterized the extracranial ICA configurations into mid-cervical flame-shaped, proximal blunt/beak-shaped, and tubular-shaped groups. 4D whole brain CTA was used as a reference standard for intracranial ICA occlusion detection. Diagnostic performance of the mid-cervical flame-shaped extracranial ICA sign and interobserver reliability were calculated. Of the 81 cases, 11 had isolated intracranial ICA occlusion, and 6 had true extracranial ICA occlusion. Mid-cervical flame-shaped extracranial ICA sign was found in 45.5% (5/11) of isolated intracranial ICA occlusions but none in the true extracranial ICA occlusion group. The sensitivity, specificity, PPV, NPV, and accuracy of the mid-cervical flame-shaped extracranial ICA sign for the detection of isolated intracranial ICA occlusion were 45.5, 100, 100, 92.1, and 92.6%, respectively. Interobserver reliability was 0.90. The mid-cervical flame-shaped extracranial ICA sign may suggest the presence of isolated intracranial ICA occlusion and allow reliable exclusion of tandem extracranial-intracranial ICA occlusion in hyperacute ischemic stroke setting. (orig.)

  18. Causes of Death Data in the Global Burden of Disease Estimates for Ischemic and Hemorrhagic Stroke

    DEFF Research Database (Denmark)

    Truelsen, Thomas; Krarup, Lars-Henrik; Iversen, Helle K

    2015-01-01

    on the International Classification of Diseases and the pathology behind each code by checking multiple causes of death and literature review. RESULTS: Unspecified stroke and primary and secondary hypertension are leading contributing 'GCs' to stroke mortality estimates for hemorrhagic stroke (HS) and ischemic stroke...... (IS). There were marked differences in the fraction of death assigned to IS and HS for unspecified stroke and hypertension between GBD regions and between age groups. CONCLUSIONS: A large proportion of stroke fatalities are derived from the redistribution of 'unspecified stroke' and 'hypertension...

  19. Incorporation of international virtual teams as a complementary component to the traditional educational model Incorporación de virtual teams internacionales como componente complementario al modelo educativo tradicional

    Directory of Open Access Journals (Sweden)

    Carlos Fernando Arbeláez

    2012-08-01

    Full Text Available The model of virtual teams in higher education is being increasingly recognized as a phenomenon of great value to students about learning environments in the real world (Hsieh, Jang, Hwang, & Chen, 2011. Meanwhile, today’s environment requires from educational institutions dedicated to instruction undergraduate and graduate students, a rapid evolution of their models of teaching in order to conform to the same speed with which all fields transform in knowledge. This paper discusses the inclusion of virtual teams in the top-level educational models, meaning that incorporation as an option applies to all educational institutions, and above all, to their learning traditional structures. In this sense, the document includes analysis of relevant academic literature and data collected through interviews, conducted at six higher education faculty, who work in virtual teams schemes globally.El modelo de virtual teams en la educación superior está siendo reconocido cada vez máscomo un fenómeno de gran valor que acerca a los estudiantes a ambientes de aprendizajeen el mundo real (Hsieh, Jang, Hwang, & Chen, 2011. Por su parte, el entorno de hoyexige a las instituciones educativas dedicadas a la formación profesional en pregrado y posgrado, una rápida evolución de sus modelos de enseñanza a fin de ajustarlos a la mismavelocidad con la que se transforman todos los campos relacionados con el conocimiento.Este documento analiza la inclusión de virtual teams en los modelos educativos denivel superior, entendiendo dicha incorporación como una opción aplicable a todas lasinstituciones educativas, y sobre todo, a sus estructuras tradicionales de aprendizaje.En ese sentido, el documento incluye análisis de publicaciones académicas relevantes ydatos recopilados a través de entrevistas en profundidad, realizadas a seis profesores deeducación superior, quienes trabajan en esquemas de virtual teams a nivel global.

  20. Regional variation in acute stroke care organisation.

    Science.gov (United States)

    Muñoz Venturelli, Paula; Robinson, Thompson; Lavados, Pablo M; Olavarría, Verónica V; Arima, Hisatomi; Billot, Laurent; Hackett, Maree L; Lim, Joyce Y; Middleton, Sandy; Pontes-Neto, Octavio; Peng, Bin; Cui, Liying; Song, Lily; Mead, Gillian; Watkins, Caroline; Lin, Ruey-Tay; Lee, Tsong-Hai; Pandian, Jeyaraj; de Silva, H Asita; Anderson, Craig S

    2016-12-15

    Few studies have assessed regional variation in the organisation of stroke services, particularly health care resourcing, presence of protocols and discharge planning. Our aim was to compare stroke care organisation within middle- (MIC) and high-income country (HIC) hospitals participating in the Head Position in Stroke Trial (HeadPoST). HeadPoST is an on-going international multicenter crossover cluster-randomized trial of 'sitting-up' versus 'lying-flat' head positioning in acute stroke. As part of the start-up phase, one stroke care organisation questionnaire was completed at each hospital. The World Bank gross national income per capita criteria were used for classification. 94 hospitals from 9 countries completed the questionnaire, 51 corresponding to MIC and 43 to HIC. Most participating hospitals had a dedicated stroke care unit/ward, with access to diagnostic services and expert stroke physicians, and offering intravenous thrombolysis. There was no difference for the presence of a dedicated multidisciplinary stroke team, although greater access to a broad spectrum of rehabilitation therapists in HIC compared to MIC hospitals was observed. Significantly more patients arrived within a 4-h window of symptoms onset in HIC hospitals (41 vs. 13%; Porganisation and treatment. Future multilevel analyses aims to determine the influence of specific organisational factors on patient outcomes. Copyright © 2016 Elsevier B.V. All rights reserved.

  1. [Ischemic stroke in the young adult].

    Science.gov (United States)

    Calvet, D

    2016-01-01

    Ischemic stroke is not rare in young adults since one in ten stroke patients are less than 50 years old. This incidence increased over the past last years, mainly due to the rise in the prevalence of traditional vascular risk factors in this sub-group of age but also of illegal drug use. Even though both survival and functional outcome of young stroke patients are better than those observed in older patients, socio-economic and quality of life consequences make this disease a main objective in terms of primary and secondary prevention. Identifying the cause of ischemic stroke in young adults is of major importance to prevent stroke recurrence. However, given the wide variety of potential underlying causes, the etiologic work-up of stroke in young adults requires a different approach from that in the elderly. In this context, a sequential diagnostic work-up is needed in order to optimize the yield of diagnostic tests, to reduce their cost and risks for the patient. Arterial dissection is the most frequent cause of stroke in young adults but other less frequent causes are numerous. Despite a comprehensive work-up, about one third of cases remains unexplained leading to the diagnosis of cryptogenic ischemic stroke. Copyright © 2015 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  2. National data on stroke outcomes in Thailand.

    Science.gov (United States)

    Kongbunkiat, Kannikar; Kasemsap, Narongrit; Thepsuthammarat, Kaewjai; Tiamkao, Somsak; Sawanyawisuth, Kittisak

    2015-03-01

    Stroke is a major public health problem worldwide. There are limited data on national stroke prevalence and outcomes after the beginning of the thrombolytic therapy era in Thailand. This study aimed to investigate the prevalence and factors associated with mortality in stroke patients in Thailand using the national reimbursement databases. Clinical data retrieved included individuals under the universal coverage, social security, and civil servant benefit systems between 1 October 2009 and 30 September 2010. The stroke diagnosis code was based on the International Classification of Diseases 10th revision system including G45 (transient cerebral ischemic attacks and related syndromes), I61 (intracerebral hemorrhage), and I63 (cerebral infarction). The prevalence and stroke outcomes were calculated from these coded data. Factors associated with death were evaluated by multivariable logistic regression analysis. We found that the most frequent stroke subtype was cerebral infarction with a prevalence of 122 patients per 100,000 of population, an average length of hospital stay of 6.8 days, an average hospital charge of 20,740 baht (∼$USD 691), a mortality rate of 7%, and thrombolytic prescriptions of 1%. The significant factors associated with stroke mortality were septicemia, pulmonary embolism, pneumonia, myocardial infarction, status epilepticus, and heart failure. In conclusion, the prevalence and outcomes of stroke in Thailand were comparable with other countries. The era of thrombolytic therapy has just begun in Thailand. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Stroke prevention in atrial fibrillation--an Asian stroke perspective.

    Science.gov (United States)

    Tse, Hung-Fat; Wang, Yong-Jun; Ahmed Ai-Abdullah, Moheeb; Pizarro-Borromeo, Annette B; Chiang, Chern-En; Krittayaphong, Rungroj; Singh, Balbir; Vora, Amit; Wang, Chun-Xue; Zubaid, Mohammad; Clemens, Andreas; Lim, Paul; Hu, Dayi

    2013-07-01

    Despite relatively lower prevalence of atrial fibrillation (AF) in Asians (~1%) than in Caucasians (~2%), Asia has a much higher overall disease burden because of its proportionally larger aged population. For example, on the basis of reported age-adjusted prevalence rates and projected population figures in China, there will be an estimated 5.2 million men and 3.1 million women with AF older than 60 years by year 2050. Stroke is a disabling complication of AF that is of increasing cause for concern in Asians patients. Implementing consensus expert recommendations for managing stroke risk in patients with AF can considerably reduce stroke rates. However, caution is necessary when aligning management of Asian patients with AF to that of their Caucasian counterparts. Current international guidelines and risk stratification tools for AF management are based on findings in predominantly Caucasian populations and may therefore have limited relevance, in certain respects, to Asian patients. Oral anticoagulants play an important role in preventing AF-related stroke. The vitamin K antagonist warfarin is recommended for reducing the risk of stroke and thromboembolism in high-risk patients with nonvalvular AF; however, warfarin interacts with many drugs and food ingredients, which may pose significant challenges in administration and monitoring among Asian patients. Further research is needed to inform specific guidance on the implications of different stroke and bleeding profiles in Asians vs Caucasians. Moreover, there is scope to improve physician perceptions and patient knowledge, as well as considering alternative new oral anticoagulants, for example, direct thrombin inhibitors or factor Xa inhibitors. Copyright © 2013 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  4. Airplane stroke syndrome.

    Science.gov (United States)

    Humaidan, Hani; Yassi, Nawaf; Weir, Louise; Davis, Stephen M; Meretoja, Atte

    2016-07-01

    Only 37 cases of stroke during or soon after long-haul flights have been published to our knowledge. In this retrospective observational study, we searched the Royal Melbourne Hospital prospective stroke database and all discharge summaries from 1 September 2003 to 30 September 2014 for flight-related strokes, defined as patients presenting with stroke within 14days of air travel. We hypothesised that a patent foramen ovale (PFO) is an important, but not the only mechanism, of flight-related stroke. We describe the patient, stroke, and flight characteristics. Over the study period, 131 million passengers arrived at Melbourne airport. Our centre admitted 5727 stroke patients, of whom 42 (0.73%) had flight-related strokes. Flight-related stroke patients were younger (median age 65 versus 73, p<0.001), had similar stroke severity, and received intravenous thrombolysis more often than non-flight-related stroke patients. Seven patients had flight-related intracerebral haemorrhage. The aetiology of the ischaemic strokes was cardioembolic in 14/35 (40%), including seven patients with confirmed PFO, one with atrial septal defect, four with atrial fibrillation, one with endocarditis, and one with aortic arch atheroma. Paradoxical embolism was confirmed in six patients. Stroke related to air travel is a rare occurrence, less than one in a million. Although 20% of patients had a PFO, distribution of stroke aetiologies was diverse and was not limited to PFO and paradoxical embolism. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Achieving a holistic perspective in stroke rehabilitation

    DEFF Research Database (Denmark)

    Kristensen, Hanne Kaae; Lund, Hans; Jones, Dorrie

    2015-01-01

    Background/Aims: Holistic, multidisciplinary rehabilitation is often the most appropriate for stroke patients. The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) provides a comprehensive conceptual framework and systematic terminology used...... to a holistic approach in stroke rehabilitation, including an understanding of functioning and the ability to participate in everyday life. Using this approach to rehabilitation, disability is not only perceived as a consequence of stroke but also in the context of the individual person, where interactions...... the holistic approach....

  6. Long-Term Cognitive Impairment After First-Ever Ischemic Stroke in Young Adults

    NARCIS (Netherlands)

    Schaapsmeerders, P.; Maaijwee, N.A.M.M.; Dijk, E.J. van; Rutten-Jacobs, L.C.A.; Arntz, R.M.; Schoonderwaldt, H.C.; Dorresteijn, L.D.A.; Kessels, R.P.C.; Leeuw, H.F. de

    2013-01-01

    Background and Purpose—Up to 14% of all ischemic strokes occur in young adults (<50 years). Poststroke cognitive performance is a decisive determinant of their quality of life. However, virtually no studies report on cognition after young stroke, especially not on the long term. This long-term

  7. Long-term cognitive impairment after first-ever ischemic stroke in young adults

    NARCIS (Netherlands)

    Schaapsmeerders, P.; Maaijwee, N.A.M.M.; Dijk, E.J. van; Rutten-Jacobs, L.C.A.; Arntz, R.M.; Schoonderwaldt, H.C.; Dorresteijn, L.D.A.; Kessels, R.P.C.; Leeuw, F.E. de

    2013-01-01

    BACKGROUND AND PURPOSE: Up to 14% of all ischemic strokes occur in young adults (<50 years). Poststroke cognitive performance is a decisive determinant of their quality of life. However, virtually no studies report on cognition after young stroke, especially not on the long term. This long-term

  8. Stroke Risk and Mortality in Patients With Ventricular Assist Devices.

    Science.gov (United States)

    Parikh, Neal S; Cool, Joséphine; Karas, Maria G; Boehme, Amelia K; Kamel, Hooman

    2016-11-01

    Ventricular assist devices (VADs) have advanced the management of end-stage heart failure. However, these devices are associated with hemorrhagic and thrombotic complications, including stroke. We assessed the incidence, risk factors, and outcomes of ischemic and hemorrhagic stroke after VAD placement. Using administrative claims data from acute care hospitals in California, Florida, and New York from 2005 to 2013, we identified patients who underwent VAD placement, defined by the International Classification of Diseases, Ninth Revision, Clinical Modification code 37.66. Ischemic and hemorrhagic strokes were identified by previously validated coding algorithms. We used survival statistics to determine the incidence rates and Cox proportional hazard analyses to examine the associations. Among 1813 patients, we identified 201 ischemic strokes and 116 hemorrhagic strokes during 3.4 (±2.0) years of follow-up after implantation of a VAD. The incidence of stroke was 8.7% per year (95% confidence interval [CI], 7.7-9.7). The annual incidence of ischemic stroke (5.5%; 95% CI, 4.8-6.4) was nearly double that of hemorrhagic stroke (3.1%; 95% CI, 2.6-3.8). Women faced a higher hazard of stroke than men (hazard ratio, 1.6; 95% CI, 1.2-2.1), particularly hemorrhagic stroke (hazard ratio, 2.2; 95% CI, 1.4-3.4). Stroke was strongly associated with subsequent in-hospital mortality (hazard ratio, 6.1; 95% CI, 4.6-7.9). The incidence of stroke after VAD implantation was 8.7% per year, and incident stroke was strongly associated with subsequent in-hospital mortality. Notably, ischemic stroke occurred at nearly twice the rate of hemorrhagic stroke. Women seemed to face a higher risk for hemorrhagic stroke than men. © 2016 American Heart Association, Inc.

  9. Difficulty Swallowing After Stroke (Dysphagia)

    Science.gov (United States)

    ... Stroke Heroes Among Us Difficulty Swallowing After Stroke (Dysphagia) Updated:Nov 15,2016 Excerpted and adapted from "Swallowing Disorders After a Stroke," Stroke Connection Magazine July/August ...

  10. Virtual rehabilitation--benefits and challenges.

    Science.gov (United States)

    Burdea, G C

    2003-01-01

    To discuss the advantages and disadvantages of rehabilitation applications of virtual reality. VR can be used as an enhancement to conventional therapy for patients with conditions ranging from musculoskeletal problems, to stroke-induced paralysis, to cognitive deficits. This approach is called "VR-augmented rehabilitation." Alternately, VR can replace conventional interventions altogether, in which case the rehabilitation is "VR-based." If the intervention is done at a distance, then it is called "telerehabilitation." Simulation exercises for post-stroke patients have been developed using a "teacher object" approach or a video game approach. Simulations for musculo-skeletal patients use virtual replicas of rehabilitation devices (such as rubber ball, power putty, peg board). Phobia-inducing virtual environments are prescribed for patients with cognitive deficits. VR-augmented rehabilitation has been shown effective for stroke patients in the chronic phase of the disease. VR-based rehabilitation has been improving patients with fear of flying, Vietnam syndrome, fear of heights, and chronic stroke patients. Telerehabilitation interventions using VR have improved musculo-skeletal and post-stroke patients, however less data is available at this time. Virtual reality presents significant advantages when applied to rehabilitation of patients with varied conditions. These advantages include patient motivation, adaptability and variability based on patient baseline, transparent data storage, online remote data access, economy of scale, reduced medical costs. Challenges in VR use for rehabilitation relate to lack of computer skills on the part of therapists, lack of support infrastructure, expensive equipment (initially), inadequate communication infrastructure (for telerehabilitation in rural areas), and patient safety concerns.

  11. Creating Virtual-hand and Virtual-face Illusions to Investigate Self-representation.

    Science.gov (United States)

    Ma, Ke; Lippelt, Dominique P; Hommel, Bernhard

    2017-03-01

    Studies investigating how people represent themselves and their own body often use variants of "ownership illusions", such as the traditional rubber-hand illusion or the more recently discovered enfacement illusion. However, these examples require rather artificial experimental setups, in which the artificial effector needs to be stroked in synchrony with the participants' real hand or face-a situation in which participants have no control over the stroking or the movements of their real or artificial effector. Here, we describe a technique to establish ownership illusions in a setup that is more realistic, more intuitive, and of presumably higher ecological validity. It allows creating the virtual-hand illusion by having participants control the movements of a virtual hand presented on a screen or in virtual space in front of them. If the virtual hand moves in synchrony with the participants' own real hand, they tend to perceive the virtual hand as part of their own body. The technique also creates the virtual-face illusion by having participants control the movements of a virtual face in front of them, again with the effect that they tend to perceive the face as their own if it moves in synchrony with their real face. Studying the circumstances that illusions of this sort can be created, increased, or reduced provides important information about how people create and maintain representations of themselves.

  12. Virtual Vision

    Science.gov (United States)

    Terzopoulos, Demetri; Qureshi, Faisal Z.

    Computer vision and sensor networks researchers are increasingly motivated to investigate complex multi-camera sensing and control issues that arise in the automatic visual surveillance of extensive, highly populated public spaces such as airports and train stations. However, they often encounter serious impediments to deploying and experimenting with large-scale physical camera networks in such real-world environments. We propose an alternative approach called "Virtual Vision", which facilitates this type of research through the virtual reality simulation of populated urban spaces, camera sensor networks, and computer vision on commodity computers. We demonstrate the usefulness of our approach by developing two highly automated surveillance systems comprising passive and active pan/tilt/zoom cameras that are deployed in a virtual train station environment populated by autonomous, lifelike virtual pedestrians. The easily reconfigurable virtual cameras distributed in this environment generate synthetic video feeds that emulate those acquired by real surveillance cameras monitoring public spaces. The novel multi-camera control strategies that we describe enable the cameras to collaborate in persistently observing pedestrians of interest and in acquiring close-up videos of pedestrians in designated areas.

  13. Virtual Technologies and Social Shaping

    OpenAIRE

    Kreps , David

    2010-01-01

    International audience; Virtual Technologies have enabled us all to become publishers and broadcasters. The world of information has become saturated with a multitude of opinions, and opportunities to express them. Track 2 "Virtual Technologies and Social Shaping" of the 9th Conference on Human Choice and Computers (HCC9) explores some of the issues that have arisen in this new information society, how we are shaped by it, and how we shape it, through i) two papers addressing issues of identi...

  14. Virtual Tower

    International Nuclear Information System (INIS)

    Wayne, R.A.

    1997-01-01

    The primary responsibility of an intrusion detection system (IDS) operator is to monitor the system, assess alarms, and summon and coordinate the response team when a threat is acknowledged. The tools currently provided to the operator are somewhat limited: monitors must be switched, keystrokes must be entered to call up intrusion sensor data, and communication with the response force must be maintained. The Virtual tower is an operator interface assembled from low-cost commercial-off-the-shelf hardware and software; it enables large amounts of data to be displayed in a virtual manner that provides instant recognition for the operator and increases assessment accuracy in alarm annunciator and control systems. This is accomplished by correlating and fusing the data into a 360-degree visual representation that employs color, auxiliary attributes, video, and directional audio to prompt the operator. The Virtual Tower would be a valuable low-cost enhancement to existing systems

  15. Virtual care

    DEFF Research Database (Denmark)

    Kamp, Annette; Aaløkke Ballegaard, Stinne

    of retrenchment, promising better quality, empowerment of citizens and work that is smarter and more qualified. Through ethnographic field studies we study the introduction of virtual home care in Danish elderly care, focusing on the implications for relational work and care relations. Virtual home care entails...... the performance of specific home care services by means of video conversations rather than physical visits in the citizens’ homes. As scholars within the STS tradition maintain, technologies do not simply replace a human function; they rather transform care work, redistributing tasks between citizens, technology...... point out how issues of trust and surveillance, which are always negotiated in care relations, are in fact accentuated in this kind of virtual care work. Moreover, we stress that the contemporary institutional context, organization and time schedules have a vast impact on the practices developed....

  16. Virtual toolbox

    Science.gov (United States)

    Jacobus, Charles J.; Jacobus, Heidi N.; Mitchell, Brian T.; Riggs, A. J.; Taylor, Mark J.

    1993-04-01

    At least three of the five senses must be fully addressed in a successful virtual reality (VR) system. Sight, sound, and touch are the most critical elements for the creation of the illusion of presence. Since humans depend so much on sight to collect information about their environment, this area has been the focus of much of the prior art in virtual reality, however, it is also crucial that we provide facilities for force, torque, and touch reflection, and sound replay and 3-D localization. In this paper we present a sampling of hardware and software in the virtual environment maker's `toolbox' which can support rapidly building up of customized VR systems. We provide demonstrative examples of how some of the tools work and we speculate about VR applications and future technology needs.

  17. Concept of Six Stroke Engine

    OpenAIRE

    P.Naresh

    2015-01-01

    One of the most difficult challenges in engine technology today is the urgent need to increase engine thermal efficiency. Higher efficiencies mean less fuel consumption and lower atmospheric emissions per unit of work produced by the engine. In 1862 a Frenchman Alphouse Beau de Rochas gives his theory regarding the ideal cycle of the internal combustion engine. This theory is applied by a German engineer named Nikolaus A. Otto, who firstly built a successful four-stroke SI engine in 1876. The...

  18. Virtual polytopes

    International Nuclear Information System (INIS)

    Panina, G Yu; Streinu, I

    2015-01-01

    Originating in diverse branches of mathematics, from polytope algebra and toric varieties to the theory of stressed graphs, virtual polytopes represent a natural algebraic generalization of convex polytopes. Introduced as elements of the Grothendieck group associated to the semigroup of convex polytopes, they admit a variety of geometrizations. The present survey connects the theory of virtual polytopes with other geometrical subjects, describes a series of geometrizations together with relations between them, and gives a selection of applications. Bibliography: 50 titles

  19. Upper limb assessment using a Virtual Peg Insertion Test.

    Science.gov (United States)

    Fluet, Marie-Christine; Lambercy, Olivier; Gassert, Roger

    2011-01-01

    This paper presents the initial evaluation of a Virtual Peg Insertion Test developed to assess sensorimotor functions of arm and hand using an instrumented tool, virtual reality and haptic feedback. Nine performance parameters derived from kinematic and kinetic data were selected and compared between two groups of healthy subjects performing the task with the dominant and non-dominant hand, as well as with a group of chronic stroke subjects suffering from different levels of upper limb impairment. Results showed significantly smaller grasping forces applied by the stroke subjects compared to the healthy subjects. The grasping force profiles suggest a poor coordination between position and grasping for the stroke subjects, and the collision forces with the virtual board were found to be indicative of sensory deficits. These preliminary results suggest that the analyzed parameters could be valid indicators of impairment. © 2011 IEEE

  20. Brain Basics: Preventing Stroke

    Science.gov (United States)

    ... NINDS) are committed to reducing that burden through biomedical research. What is a Stroke? A stroke, or "brain ... Testimony Legislative Updates Impact NINDS Contributions to Approved Therapies ... Director, Division of Intramural Research

  1. Stroke Warning Signs

    Science.gov (United States)

    ... person to repeat a simple sentence, like "The sky is blue." Is the person able to correctly ... to Your Doctor to Create a Plan The Life After Stroke Journey Every stroke recovery is different. ...

  2. [Genetics of ischemic stroke].

    Science.gov (United States)

    Gschwendtner, A; Dichgans, M

    2013-02-01

    Stroke is one of the most widespread causes of mortality und disability worldwide. Around 80 % of strokes are ischemic and different forms of intracranial bleeding account for the remaining cases. Monogenic stroke disorders are rare but the diagnosis may lead to specific therapeutic consequences for the affected patients who are predominantly young. In common sporadic stroke, genetic factors play a role in the form of susceptibility genes. Their discovery may give rise to new therapeutic options in the future.

  3. A prospective cohort study of stroke characteristics, care, and mortality in a hospital stroke registry in Vietnam

    Directory of Open Access Journals (Sweden)

    Tirschwell David L

    2012-12-01

    Full Text Available Abstract Background As low and middle-income countries such as Vietnam experience the health transition from infectious to chronic diseases, the morbidity and mortality from stroke will rise. In line with the recommendation of the Institute of Medicine’s report on “Promoting Cardiovascular Health in the Developing World” to “improve local data”, we sought to investigate patient characteristics and clinical predictors of mortality among stroke inpatients at Da Nang Hospital in Vietnam. Methods A stroke registry was developed and implemented at Da Nang Hospital utilizing the World Health Organization’s Stroke STEPS instrument for data collection. Results 754 patients were hospitalized for stroke from March 2010 through February 2011 and admitted to either the intensive care unit or cardiology ward. Mean age was 65 years, and 39% were female. Nearly 50% of strokes were hemorrhagic. At 28-day follow-up, 51.0% of patients with hemorrhagic stroke died whereas 20.3% of patients with ischemic stroke died. A number of factors were independently associated with 28-day mortality; the two strongest independent predictors were depressed level of consciousness on presentation and hemorrhagic stroke type. While virtually all patients completed a CT during the admission, evidence-based processes of care such as anti-thrombotic therapy and carotid ultrasound for ischemic stroke patients were underutilized. Conclusions This cohort study highlights the high mortality due in part to the large proportion of hemorrhagic strokes in Vietnam. Lack of hypertension awareness and standards of care exacerbated clinical outcomes. Numerous opportunities for simple, inexpensive interventions to improve outcomes or reduce recurrent stroke have been identified.

  4. Virtual Savannah

    DEFF Research Database (Denmark)

    Rodil, Kasper; Eskildsen, Søren; Rehm, Matthias

    2012-01-01

    Virtual Savannah is constructed to visualize parts of a curriculum, which the educational service at Aalborg Zoo has difficulties in teaching children visiting the zoo. It contains rich media like audio, text, video and picture galleries about African ecology, but some of this episodic information...

  5. Virtual Reality.

    Science.gov (United States)

    Newby, Gregory B.

    1993-01-01

    Discusses the current state of the art in virtual reality (VR), its historical background, and future possibilities. Highlights include applications in medicine, art and entertainment, science, business, and telerobotics; and VR for information science, including graphical display of bibliographic data, libraries and books, and cyberspace.…

  6. Virtualize Me!

    Science.gov (United States)

    Waters, John K.

    2009-01-01

    John Abdelmalak, director of technology for the School District of the Chathams, was pretty sure it was time to jump on the virtualization bandwagon last year when he invited Dell to conduct a readiness assessment of his district's servers. When he saw just how little of their capacity was being used, he lost all doubt. Abdelmalak is one of many…

  7. Virtual Classroom

    DEFF Research Database (Denmark)

    Christensen, Ove

    2013-01-01

    In the Scandinavian countries: Sweden, Norway and Denmark, the project GNU (Grænseoverskridende Nordisk Undervisning, i.e. Transnational Nordic Teaching) is experimenting with ways of conducting teaching across the borders in the elementary schools. The cloud classes are organised with one class...... and benefits in regard to learning and pedagogy with virtual classroom....

  8. Virtual landmarks

    Science.gov (United States)

    Tong, Yubing; Udupa, Jayaram K.; Odhner, Dewey; Bai, Peirui; Torigian, Drew A.

    2017-03-01

    Much has been published on finding landmarks on object surfaces in the context of shape modeling. While this is still an open problem, many of the challenges of past approaches can be overcome by removing the restriction that landmarks must be on the object surface. The virtual landmarks we propose may reside inside, on the boundary of, or outside the object and are tethered to the object. Our solution is straightforward, simple, and recursive in nature, proceeding from global features initially to local features in later levels to detect landmarks. Principal component analysis (PCA) is used as an engine to recursively subdivide the object region. The object itself may be represented in binary or fuzzy form or with gray values. The method is illustrated in 3D space (although it generalizes readily to spaces of any dimensionality) on four objects (liver, trachea and bronchi, and outer boundaries of left and right lungs along pleura) derived from 5 patient computed tomography (CT) image data sets of the thorax and abdomen. The virtual landmark identification approach seems to work well on different structures in different subjects and seems to detect landmarks that are homologously located in different samples of the same object. The approach guarantees that virtual landmarks are invariant to translation, scaling, and rotation of the object/image. Landmarking techniques are fundamental for many computer vision and image processing applications, and we are currently exploring the use virtual landmarks in automatic anatomy recognition and object analytics.

  9. Personal Virtual Libraries

    Science.gov (United States)

    Pappas, Marjorie L.

    2004-01-01

    Virtual libraries are becoming more and more common. Most states have a virtual library. A growing number of public libraries have a virtual presence on the Web. Virtual libraries are a growing addition to school library media collections. The next logical step would be personal virtual libraries. A personal virtual library (PVL) is a collection…

  10. Stroke care: Experiences and clinical research in stroke units in Chennai

    Directory of Open Access Journals (Sweden)

    Gobindram Arjundas

    2006-01-01

    Full Text Available Background: S troke is the second commonest cause of death in India with crude overall prevalence rate of 220 per 100,000. With an increasing aging population at risk, the stroke burden in India can be expected to reach epidemic proportions. Materials and Methods: The first protocol-based prospective studies, funded by private agencies was conducted in Madras Institute of Neurology in 1984-86. The results led to establishment of the first stroke unit in Tamil Nadu state, in the institute. The first all-India hospital-based studies in acute stroke was completed as INDIAN COOPERATIVE ACUTE STROKE STUDIES (ICASS I and ICASS II with WHO STEP ONE by members of the Indian Stroke Association between 2000-2005. This has generated very useful data for our country. Results: Mortality in 1984-86 was 40%. Stroke unit in the institute dropped it to 12%. About 10 years later, ICASS studies showed a further fall of mortality to 8%, which is the current international figure in the west. Morbidity pattern showed about half return to their original activities. But about one third are left totally disabled needing prolonged care, for which fiscal, social and rehab provisions have to be done on a national basis. Conclusions: The progress and success of care of Stroke in the last three decades, from treatment in medical and neurology wards to specialized stroke units is presented. The main risk factors are hypertension, diabetes and ischemic heart disease across the country. Hypertension alone or with the other two diseases was present in 72% of cases. Prevention and treatment of these factors will reduce the stroke burden, mortality and morbidity of strokes. The Stroke-team concept can be extended to the smallest hospitals in our country.

  11. Knowledge of stroke among stroke patients and their relatives in Northwest India.

    Science.gov (United States)

    Pandian, Jeyaraj Durai; Kalra, Guneet; Jaison, Ashish; Deepak, Sukhbinder Singh; Shamsher, Shivali; Singh, Yashpal; Abraham, George

    2006-06-01

    The knowledge of warning symptoms and risk factors for stroke has not been studied among patients with stroke in developing countries. We aimed to assess the knowledge of stroke among patients with stroke and their relatives. Prospective tertiary referral hospital-based study in Northwest India. Trained nurses and medical interns interviewed patients with stroke and transient ischemic attack and their relatives about their knowledge of stroke symptoms and risk factors. Univariable and multivariable logistic regression were used. Of the 147 subjects interviewed, 102 (69%) were patients and 45 (31%) were relatives. There were 99 (67%) men and 48 (33%) women and the mean age was 59.7+/-14.1 years. Sixty-two percent of respondents recognized paralysis of one side as a warning symptom and 54% recognized hypertension as a risk factor for stroke. In the multivariable logistic regression analysis, higher education was associated with the knowledge of correct organ involvement in stroke (OR 2.6, CI 1.1- 6.1, P =0.02), whereas younger age (OR 2.7, CI 1.1-7.0, P =0.04) and higher education (OR 4.1, CI 1.5-10.9, P =0.005) correlated with a better knowledge regarding warning symptoms of stroke. In this study cohort, in general, there is lack of awareness of major warning symptoms, risk factors, organ involvement and self-recognition of stroke. However younger age and education status were associated with better knowledge. There is an urgent need for awareness programs about stroke in this study cohort.

  12. Top of the basilar artery embolic stroke and neonatal myoclonus

    NARCIS (Netherlands)

    Govaert, Paul; Dudink, Jeroen; Visser, Gerhard; Breukhoven, Petra; Vanhatalo, Sampsa; Lequin, Maarten

    Cerebellar stroke has been virtually unreported in the living newborn infant. A term newborn male weighing 3380g at birth suffered myoclonic seizures within 24 hours of birth by spontaneous vaginal delivery. Apgar scores were 3 and 4 at 1 and 5 minutes. Myoclonus persisted for 9 days, responding

  13. Sex Disparities in Stroke

    DEFF Research Database (Denmark)

    Dehlendorff, Christian; Andersen, Klaus Kaae; Olsen, Tom Skyhøj

    2015-01-01

    between 2003 and 2012 (N=79 617), and the Danish Register of Causes of Death. Information was available on age, sex, marital status, stroke severity, stroke subtype, socioeconomic status, and cardiovascular risk profile. We studied only deaths due to the index stroke, with the assumption that death.......5%) or 1 month (6.9%), respectively. After the age of 60 years, women had more severe strokes than men. Up to ages in the mid-60s, no difference in the risk of death from stroke was seen between the 2 sexes. For people aged >65 years, however, the risk gradually became greater in men than in women...

  14. Seizure development after stroke.

    Science.gov (United States)

    Misirli, H; Ozge, A; Somay, G; Erdoğan, N; Erkal, H; Erenoğlu, N Y

    2006-12-01

    Although there have been many studies on seizures following stroke, there is still much we do not know about them. In this study, we evaluated the characteristics of seizures in stroke patients. There were 2267 patients with a first-ever stroke, and after excluding 387 patients, 1880 were available for analysis. Of these 1880 patients, we evaluated 200 patients with seizures and 400 patients without seizures. We investigated the seizures according to age, gender, stroke type, the aetiology of ischaemic stroke and the localisation of the lesion. The seizures were classified as early onset and late onset and the seizure type as partial, generalised or secondarily generalised. Seizures occurred in 200 (10.6%) of 1880 strokes. The number of patients with seizures were 138 (10.6%) in ischaemic stroke group and 62 (10.7%) in haemorrhagic stroke group. Patients with ischaemic strokes had 41 embolic (29.7%) and 97 thrombotic (70.3%) origin, and these were not statistically significant in comparison with controls. Cortical involvement for the development of seizures was the most important risk factor (odds ratios = 4.25, p < 0.01). It was concluded that embolic strokes, being younger than 65 years old, and cortical localisation of stroke were important risks for developing seizures.

  15. Clinical Epidemiology Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D

    2005-01-01

    Full Text Available Stroke is a huge public health problem because of its high morbidity and disability. The epidemiology of stroke is of relevance to construct practical paradigms to tackle this major health issue in the community. Recent data have shown that about 72-86% of strokes are ischemic, 9-18% are due to hemorrhage (intracerebral of subarachnoid and the rest are undefined. The risk factors for stroke are multiple and combined. At present, stroke is no more considered as unavoidable and untreatable. It is an emergency and specialized units and teams improve outcome and lower costs. Death related to stroke is declining in many countries and in both sexes. This decrease in multifactorial. The detection and more effective treatment of hypertension may play an important factor, as well as the improved medical care and improvement in diagnostic procedures. While stroke incidence appears stable and stroke mortality is slowly declining, the absolute magnitude of stroke is likely to grow over the next 30 years. as the population ages, the absolute number of stroke victims and demands on healthcare and other support systems is likely to increase substantially in the future. Keeping this in perspective, this chapter shall focus on the epidemiology of stroke in the world and in Indian, in particular.

  16. Registration of acute stroke

    DEFF Research Database (Denmark)

    Wildenschild, Cathrine; Mehnert, Frank; Thomsen, Reimar Wernich

    2014-01-01

    BACKGROUND: The validity of the registration of patients in stroke-specific registries has seldom been investigated, nor compared with administrative hospital discharge registries. The objective of this study was to examine the validity of the registration of patients in a stroke-specific registry...... (The Danish Stroke Registry [DSR]) and a hospital discharge registry (The Danish National Patient Registry [DNRP]). METHODS: Assuming that all patients with stroke were registered in either the DSR, DNRP or both, we first identified a sample of 75 patients registered with stroke in 2009; 25 patients...... in the DSR, 25 patients in the DNRP, and 25 patients registered in both data sources. Using the medical record as a gold standard, we then estimated the sensitivity and positive predictive value of a stroke diagnosis in the DSR and the DNRP. Secondly, we reviewed 160 medical records for all potential stroke...

  17. Basic characteristics of hospital stroke services in Eastern Hungary

    International Nuclear Information System (INIS)

    Mihalka, Laszlo; Fekete, Istvan; Csepany, Tuende; Csiba, Laszlo; Bereczki, Daniel

    1999-01-01

    Stroke mortality is extremely high in Central-Eastern European countries. We report basic characteristics of a stroke unit in Eastern Hungary, including age and sex distribution; the proportion of transient ischemic attacks (TIA), ischemic and hemorrhagic strokes; case fatality; application of diagnostic methods; and length of stay for all patients treated with acute cerebrovascular disease over a 12-month period. Records of all patients with acute cerebrovascular disease (n = 522) discharged in 1995 from a stroke unit with a well defined catchment area of 220,000 inhabitants in Eastern Hungary were retrospectively analyzed. Case fatality was 18.6% for all patients and 21.1% after excluding cases with TIA. Computer tomography, duplex carotid ultrasound, cerebrospinal fluid examination and electroencephalography were performed in 79%, 77%, 7% and 2% of the patients, respectively. The database of the university hospital with the same catchment area was electronically searched for patients who were discharged with the diagnosis of stroke from the three departments of internal medicine. Stroke mortality data of the catchment area based on death certificates was obtained from the Central Statistical Bureau. Two hundred twenty-eight stroke deaths were reported in the catchment area in 1995. In the same period 97 stroke deaths occurred at the stroke unit and 76 at the departments of internal medicine. If we aim to treat all patients with acute stroke at the stroke unit, with the present stroke incidence and duration of hospital stay the current capacity of the stroke unit (1 bed per 10.000 inhabitants) should be doubled

  18. Reliability and validity of the Korean standard pattern identification for stroke (K-SPI-Stroke questionnaire

    Directory of Open Access Journals (Sweden)

    Kang Byoung-Kab

    2012-04-01

    Full Text Available Abstract Background The present study was conducted to examine the reliability and validity of the ‘Korean Standard Pattern Identification for Stroke (K-SPI-Stroke’, which was developed and evaluated within the context of traditional Korean medicine (TKM. Methods Between September 2006 and December 2010, 2,905 patients from 11 Korean medical hospitals were asked to complete the K-SPI-Stroke questionnaire as a part of project ' Fundamental study for the standardization and objectification of pattern identification in traditional Korean medicine for stroke (SOPI-Stroke. Each patient was independently diagnosed by two TKM physicians from the same site according to one of four patterns, as suggested by the Korea Institute of Oriental Medicine: 1 a Qi deficiency pattern, 2 a Dampness-phlegm pattern, 3 a Yin deficiency pattern, or 4 a Fire-heat pattern. We estimated the internal consistency using Cronbach’s α coefficient, the discriminant validity using the means score of patterns, and the predictive validity using the classification accuracy of the K-SPI-Stroke questionnaire. Results The K-SPI-Stroke questionnaire had satisfactory internal consistency (α = 0.700 and validity, with significant differences in the mean of scores among the four patterns. The overall classification accuracy of this questionnaire was 65.2 %. Conclusion These results suggest that the K-SPI-Stroke questionnaire is a reliable and valid instrument for estimating the severity of the four patterns.

  19. Post-stroke disposition from a geriatric-rehabilitative stroke care area: an Italian experience

    Directory of Open Access Journals (Sweden)

    Marco Masina

    2014-02-01

    Full Text Available A large number of stroke patients cannot be discharged at home. Studies on post stroke disposition have low validity outside the country in which they are carried out because healthcare systems offer different rehabilitative and long-term facilities. Moreover absolute selection criteria for admission to rehabilitation are not available yet. Few studies on post-stroke disposition from Italian stroke units are available. Authors evaluated data of a 18-month period from a geriatric managed stroke care area where comprehensive multi-professional assessment and discharge planning are routinely carried out. Only patients discharged with diagnosis related to acute stroke were considered. Baseline characteristics, clinical, neurological and functional conditions according to the structured multidimensional assessment were prospectively collected in the stroke unit registry. Univariate and multinomial logistic regression were performed to identify independent variables associated with three discharge settings: home, rehabilitation and skilled long-term ward. Out of 188 patients evaluated, 56.4% were discharged home, 18.6% to rehabilitation and 25.0% to long-term ward. Data showed an efficient disposition to intermediate settings with a shorter length of stay compared to other international studies. Factors associated with post-stroke disposition were age, dysphagia, neurological impairment on admission (NIH-SS≥6, after stroke functional status (mRankin≥3, poor pre-stroke functional level (mRankin≥3 and hemorrhagic stroke. Dysphagia, severe neurological impairment and post-stroke disability were associated with discharge to rehabilitation and long term ward. These two settings differed in age and pre-stroke functional condition. Patients discharged to long-term wards were about 10 years older than those admitted to rehabilitative ward. Only 5% of patients discharged to rehabilitation had a pre-stroke mRankin score ≥3. Disposition to a skilled

  20. Evaluating Experiences in Different Virtual Reality Setups

    OpenAIRE

    Settgast , Volker; Pirker , Johanna; Lontschar , Stefan; Maggale , Stefan; Gütl , Christian

    2016-01-01

    Part 2: Use and Evaluation of Digital Entertainment; International audience; This paper describes the evaluation of three different scenarios in the fully immersive room-based virtual environment DAVE (Definitely Affordable Virtual Environment) and a head-mounted display, the Oculus Rift. The evaluation focuses on comparing the two immersive environments and three different scenarios (observation, emotion in a roller coaster, and interaction) in regards to typical virtual-reality characterist...

  1. Enhancing tourism with augmented and virtual reality

    OpenAIRE

    Jenny, Sandra

    2017-01-01

    Augmented and virtual reality are on the advance. In the last twelve months, several interesting devices have entered the market. Since tourism is one of the fastest growing economic sectors in the world and has become one of the major players in international commerce, the aim of this thesis was to examine how tourism could be enhanced with augmented and virtual reality. The differences and functional principles of augmented and virtual reality were investigated, general uses were described ...

  2. Worldwide R&D of Virtual Observatory

    Science.gov (United States)

    Cui, C. Z.; Zhao, Y. H.

    2008-07-01

    Virtual Observatory (VO) is a data intensive online astronomical research and education environment, taking advantages of advanced information technologies to achieve seamless and uniform access to astronomical information. The concept of VO was introduced in the late 1990s to meet the challenges brought up with data avalanche in astronomy. In the paper, current status of International Virtual Observatory Alliance, technical highlights from world wide VO projects are reviewed, a brief introduction of Chinese Virtual Observatory is given.

  3. Sensorial Virtualization: Coupling Gaming and Virtual Environment

    NARCIS (Netherlands)

    Garbaya, S.; Miraoui, C.; Wendrich, Robert E.; Lim, T.; Stanescu, I.A.; Hauge, J.B.

    2014-01-01

    Virtual reality and virtualization are currently used to design complex systems and demonstrate that they represent the functionalities of real systems. However, the design refinement of the virtual environment (VE) and distributed virtual environment (DVE) are still time consuming and costly, as it

  4. Virtual Presenters: Towards Interactive Virtual Presentations

    NARCIS (Netherlands)

    Nijholt, Antinus; Cappellini, V.; Hemsley, J.

    2005-01-01

    We discuss having virtual presenters in virtual environments that present information to visitors of these environments. Some current research is surveyed and we will look in particular to our research in the context of a virtual meeting room where a virtual presenter uses speech, gestures, pointing

  5. Virtual anthropology.

    Science.gov (United States)

    Weber, Gerhard W

    2015-02-01

    Comparative morphology, dealing with the diversity of form and shape, and functional morphology, the study of the relationship between the structure and the function of an organism's parts, are both important subdisciplines in biological research. Virtual anthropology (VA) contributes to comparative morphology by taking advantage of technological innovations, and it also offers new opportunities for functional analyses. It exploits digital technologies and pools experts from different domains such as anthropology, primatology, medicine, paleontology, mathematics, statistics, computer science, and engineering. VA as a technical term was coined in the late 1990s from the perspective of anthropologists with the intent of being mostly applied to biological questions concerning recent and fossil hominoids. More generally, however, there are advanced methods to study shape and size or to manipulate data digitally suitable for application to all kinds of primates, mammals, other vertebrates, and invertebrates or to issues regarding plants, tools, or other objects. In this sense, we could also call the field "virtual morphology." The approach yields permanently available virtual copies of specimens and data that comprehensively quantify geometry, including previously neglected anatomical regions. It applies advanced statistical methods, supports the reconstruction of specimens based on reproducible manipulations, and promotes the acquisition of larger samples by data sharing via electronic archives. Finally, it can help identify new, hidden traits, which is particularly important in paleoanthropology, where the scarcity of material demands extracting information from fragmentary remains. This contribution presents a current view of the six main work steps of VA: digitize, expose, compare, reconstruct, materialize, and share. The VA machinery has also been successfully used in biomechanical studies which simulate the stress and strains appearing in structures. Although

  6. Virtual automation.

    Science.gov (United States)

    Casis, E; Garrido, A; Uranga, B; Vives, A; Zufiaurre, C

    2001-01-01

    Total laboratory automation (TLA) can be substituted in mid-size laboratories by a computer sample workflow control (virtual automation). Such a solution has been implemented in our laboratory using PSM, software developed in cooperation with Roche Diagnostics (Barcelona, Spain), to this purpose. This software is connected to the online analyzers and to the laboratory information system and is able to control and direct the samples working as an intermediate station. The only difference with TLA is the replacement of transport belts by personnel of the laboratory. The implementation of this virtual automation system has allowed us the achievement of the main advantages of TLA: workload increase (64%) with reduction in the cost per test (43%), significant reduction in the number of biochemistry primary tubes (from 8 to 2), less aliquoting (from 600 to 100 samples/day), automation of functional testing, drastic reduction of preanalytical errors (from 11.7 to 0.4% of the tubes) and better total response time for both inpatients (from up to 48 hours to up to 4 hours) and outpatients (from up to 10 days to up to 48 hours). As an additional advantage, virtual automation could be implemented without hardware investment and significant headcount reduction (15% in our lab).

  7. Virtual Cystoscopy

    International Nuclear Information System (INIS)

    Mejia Restrepo, Jorge; Aldana S, Natalia; Munoz Sierra, Juan; Lopez Amaya, Juan

    2011-01-01

    Introduction: virtual cystoscopy is a minimally invasive procedure that facilitates the evaluation of the urinary tract, allowing intraluminal navigation through the urinary tract structures on the basis of CT imaging reconstructions. it allows detection of various pathologies of the system, through high-sensitivity, three-dimensional lesion visualization with some advantages over conventional cystoscopy. Objective: to describe the technique used for virtual cystoscopy at our institution,and present some representative cases. Materials and methods: We describe the main indications, advantages and limitations of the method, followed by a description of the technique used in our institution, and finally, we present five representative cases of bladder and urethral pathology. Conclusion: virtual cystoscopy is a sensitive technique for the diagnosis of bladder tumors, even those smaller than 5mm. it is the preferred method in patients who have contraindications for conventional cystoscopy, such as prostate hyperplasia, urethral stenoses and active haematuria.it is less invasive and has a lower complication rate when compared with conventional cystoscopy. It has limited use in the assessment of the mucosa and of small, flat lesions.

  8. Comparison of cardiovascular risk factors and survival in patients with ischemic or hemorrhagic stroke.

    Science.gov (United States)

    Henriksson, Karin M; Farahmand, Bahman; Åsberg, Signild; Edvardsson, Nils; Terént, Andreas

    2012-06-01

    Differences in risk factor profiles between patients with ischemic and hemorrhagic stroke may have an impact on subsequent mortality. To explore cardiovascular disease risk factors, including the CHADS(2) score, with survival after ischemic or hemorrhagic stroke. Between 2001 and 2005, 87 111 (83%) ischemic stroke, 12 497 (12%) hemorrhagic stroke, and 5435 (5%) patients with unspecified stroke were identified in the Swedish Stroke Register. Data on gender, age, and cardiovascular disease risk factors were linked to the Swedish Hospital Discharge and Cause of Death Registers. Adjusted odds and hazard ratios and 95% confidence interval were calculated using logistic and Cox proportional hazard regression models. Hemorrhagic stroke patients were younger than ischemic stroke patients. All cardiovascular disease risk factors studied, alone or combined in the CHADS(2) score, were associated with higher odds ratios for ischemic stroke vs. hemorrhagic stroke. Higher CHADS(2) scores and all studied risk factors except hypertension were associated with higher odds ratio for death by ischemic stroke than hemorrhagic stroke. Ischemic stroke was associated with lower early mortality (within 30 days) vs. hemorrhagic stroke (hazard ratio = 0·28, confidence interval 0·27 to 0·29). Patients with hemorrhagic stroke had a higher risk of dying within the first 30 days after stroke, but the risk of death was similar in the two groups after one-month. Hypertension was the only cardiovascular disease risk factor associated with an increased mortality rate for hemorrhagic stroke as compared to ischemic stroke. © 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.

  9. Infections Up to 76 Days After Stroke Increase Disability and Death

    DEFF Research Database (Denmark)

    Learoyd, Annastazia E; Woodhouse, Lisa; Shaw, Laurence

    2017-01-01

    Early infection after stroke is associated with a poor outcome. We aimed to determine whether delayed infections (up to 76 days post-stroke) are associated with poor outcome at 90 days. Data came from the international Efficacy of Nitric Oxide Stroke (ENOS, ISRCTN99414122) trial. Post hoc data on...

  10. Googling Stroke ASPECTS to Determine Disability: Exploratory Analysis from VISTA-Acute Collaboration.

    Directory of Open Access Journals (Sweden)

    Richard Beare

    Full Text Available The summed Alberta Stroke Program Early CT Score (ASPECTS is useful for predicting stroke outcome. The anatomical information in the CT template is rarely used for this purpose because traditional regression methods are not adept at handling collinearity (relatedness among brain regions. While penalized logistic regression (PLR can handle collinearity, it does not provide an intuitive understanding of the interaction among network structures in a way that eigenvector method such as PageRank can (used in Google search engine. In this exploratory analysis we applied graph theoretical analysis to explore the relationship among ASPECTS regions with respect to disability outcome. The Virtual International Stroke Trials Archive (VISTA was searched for patients who had infarct in at least one ASPECTS region (ASPECTS ≤ 9, ASPECTS = 10 were excluded, and disability (modified Rankin score/mRS. A directed graph was created from a cross correlation matrix (thresholded at false discovery rate of 0.01 of the ASPECTS regions and demographic variables and disability (mRS > 2. We estimated the network-based importance of each ASPECTS region by comparing PageRank and node strength measures. These results were compared with those from PLR. There were 185 subjects, average age 67.5 ± 12.8 years (55% Males. Model 1: demographic variables having no direct connection with disability, the highest PageRank was M2 (0.225, bootstrap 95% CI 0.215-0.347. Model 2: demographic variables having direct connection with disability, the highest PageRank were M2 (0.205, bootstrap 95% CI 0.194-0.367 and M5 (0.125, bootstrap 95% CI 0.096-0.204. Both models illustrate the importance of M2 region to disability. The PageRank method reveals complex interaction among ASPECTS regions with respects to disability. This approach may help to understand the infarcted brain network involved in stroke disability.

  11. Googling Stroke ASPECTS to Determine Disability: Exploratory Analysis from VISTA-Acute Collaboration.

    Science.gov (United States)

    Beare, Richard; Chen, Jian; Phan, Thanh G

    2015-01-01

    The summed Alberta Stroke Program Early CT Score (ASPECTS) is useful for predicting stroke outcome. The anatomical information in the CT template is rarely used for this purpose because traditional regression methods are not adept at handling collinearity (relatedness) among brain regions. While penalized logistic regression (PLR) can handle collinearity, it does not provide an intuitive understanding of the interaction among network structures in a way that eigenvector method such as PageRank can (used in Google search engine). In this exploratory analysis we applied graph theoretical analysis to explore the relationship among ASPECTS regions with respect to disability outcome. The Virtual International Stroke Trials Archive (VISTA) was searched for patients who had infarct in at least one ASPECTS region (ASPECTS ≤ 9, ASPECTS = 10 were excluded), and disability (modified Rankin score/mRS). A directed graph was created from a cross correlation matrix (thresholded at false discovery rate of 0.01) of the ASPECTS regions and demographic variables and disability (mRS > 2). We estimated the network-based importance of each ASPECTS region by comparing PageRank and node strength measures. These results were compared with those from PLR. There were 185 subjects, average age 67.5 ± 12.8 years (55% Males). Model 1: demographic variables having no direct connection with disability, the highest PageRank was M2 (0.225, bootstrap 95% CI 0.215-0.347). Model 2: demographic variables having direct connection with disability, the highest PageRank were M2 (0.205, bootstrap 95% CI 0.194-0.367) and M5 (0.125, bootstrap 95% CI 0.096-0.204). Both models illustrate the importance of M2 region to disability. The PageRank method reveals complex interaction among ASPECTS regions with respects to disability. This approach may help to understand the infarcted brain network involved in stroke disability.

  12. Stroke And Substance Abuse

    Directory of Open Access Journals (Sweden)

    A Chitsaz

    2017-02-01

    Full Text Available Introduction: stroke in recreational substance users can be an indirect complication, like endocarditis and cardio embolism in parenteral drug users. With some drug like cocaine, stroke appear to be the result of a direct effect. In young subjects without other risk factors provide persuasive evidence for causality . OPIATES: Heroine is the most abused opiate drug, which is administered by injection, by snorting or by smoking. Stroke affects heroin users by diverse mechanisms,. Injectors are at risk of infections endocarditis, which carries risk for both ischemic and hemorrhagic stroke. Cerebral or subarachnoid hemorrhage usually occurs after rupture of a septic (mycotic aneurysm. Heroine users can are also at risk for hemorrhagic stroke secondary to liver failure with deranged clotting and to heroin nephropathy with uremia or malignant hypertension. In some heroin users the drug it self is directly causal due to vasculitis, hypersensitivity and immunologic changes. Embolization of foreign material to brain due to mixed of heroine with quinine can cause cerebral embolism. AMPHETAMINE AND other psychostimulants: In abuser of amphetamine hemorrhagic stroke can occur, oral, intravenous, nasal, and inhalational routes of administration have been reported. Most were chronic user, but in several patients, stroke followed a first exposure. Some of amphetamine induced intracranial hemorrhages are secondary to acute hypertension, some to cerebral vacuities, and some to a combination of two. Decongestants and diet pills: Phenylpropanolamine (PPA, an amphetamine – like drug, in decongestants and diet pills, induce acute hypertension, sever headache, psychiatric symptoms, seizures and hemorrhagic stroke. Ephedrine and pseudo ephedrine are present in decongestants and bronchodilators and induce headache, tachyarrhythmia, hypertensive emergency, and hemorrhagic and occlusive stroke. Ecstasy, 3,4 Methylenedioxymethamphetamin (MDMA with amphetamine like can

  13. Secondary prevention of stroke in Saskatchewan, Canada: hypertension control.

    Science.gov (United States)

    Bartsch, Janelle Ann; Teare, Gary F; Neufeld, Anne; Hudema, Nedeene; Muhajarine, Nazeem

    2013-10-01

    and March 31, 2008. The results of this study indicate that the management of hypertension for secondary stroke prevention is sub-optimal in Saskatchewan. Although there was some improvement over the time period, approximately 40% of patients were not taking antihypertensives at 90 days after discharge from acute care. The correlates, urban/non-urban, previous use of antihypertensive drugs and effect of age modified by sex, were found to be significantly associated with receiving hypertensive secondary stroke prevention, suggesting there are modifiable factors that contribute to variations in this form of secondary stroke care quality in Saskatchewan. The results of this study suggest that there is a need for province-wide improvement to secondary stroke prevention in Saskatchewan, Canada. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

  14. Virtualization-support Cases in Engineering Education

    DEFF Research Database (Denmark)

    Soler, José

    2011-01-01

    The paper presents cases of applying hardware virtualization techniques as support for education activities in two different courses and a master thesis within the degree International MSc on Telecommunication Engineering at the Technical University of Denmark (DTU). The triggering problem...... is presented in each of the cases, together with the benefits and drawbacks of using virtualization to cope with it....

  15. Literature and art therapy in post-stroke psychological disorders.

    Science.gov (United States)

    Eum, Yeongcheol; Yim, Jongeun

    2015-01-01

    Stroke is one of the leading causes of morbidity and long-term disability worldwide, and post-stroke depression (PSD) is a common and serious psychiatric complication of stroke. PSD makes patients have more severe deficits in activities of daily living, a worse functional outcome, more severe cognitive deficits and increased mortality as compared to stroke patients without depression. Therefore, to reduce or prevent mental problems of stroke patients, psychological treatment should be recommended. Literature and art therapy are highly effective psychological treatment for stroke patients. Literature therapy divided into poetry and story therapy is an assistive tool that treats neurosis as well as emotional or behavioral disorders. Poetry can add impression to the lethargic life of a patient with PSD, thereby acting as a natural treatment. Story therapy can change the gloomy psychological state of patients into a bright and healthy story, and therefore can help stroke patients to overcome their emotional disabilities. Art therapy is one form of psychological therapy that can treat depression and anxiety in stroke patients. Stroke patients can express their internal conflicts, emotions, and psychological status through art works or processes and it would be a healing process of mental problems. Music therapy can relieve the suppressed emotions of patients and add vitality to the body, while giving them the energy to share their feelings with others. In conclusion, literature and art therapy can identify the emotional status of patients and serve as a useful auxiliary tool to help stroke patients in their rehabilitation process.

  16. Progress in sensorimotor rehabilitative physical therapy programs for stroke patients

    Science.gov (United States)

    Chen, Jia-Ching; Shaw, Fu-Zen

    2014-01-01

    Impaired motor and functional activity following stroke often has negative impacts on the patient, the family and society. The available rehabilitation programs for stroke patients are reviewed. Conventional rehabilitation strategies (Bobath, Brunnstrom, proprioception neuromuscular facilitation, motor relearning and function-based principles) are the mainstream tactics in clinical practices. Numerous advanced strategies for sensory-motor functional enhancement, including electrical stimulation, electromyographic biofeedback, constraint-induced movement therapy, robotics-aided systems, virtual reality, intermittent compression, partial body weight supported treadmill training and thermal stimulation, are being developed and incorporated into conventional rehabilitation programs. The concept of combining valuable rehabilitative procedures into “a training package”, based on the patient’s functional status during different recovery phases after stroke is proposed. Integrated sensorimotor rehabilitation programs with appropriate temporal arrangements might provide great functional benefits for stroke patients. PMID:25133141

  17. What Virtual Reality Research in Addictions Can Tell Us about the Future of Obesity Assessment and Treatment

    OpenAIRE

    Bordnick, Patrick S; Carter, Brian L; Traylor, Amy C

    2011-01-01

    Virtual reality (VR), a system of human–computer interaction that allows researchers and clinicians to immerse people in virtual worlds, is gaining considerable traction as a research, education, and treatment tool. Virtual reality has been used successfully to treat anxiety disorders such as fear of flying and post-traumatic stress disorder, as an aid in stroke rehabilitation, and as a behavior modification aid in the treatment of attention deficit disorder. Virtual reality has also been emp...

  18. Blood Pressure Control: Stroke and Stroke Prevention

    Directory of Open Access Journals (Sweden)

    Hans-Christoph Diener

    2005-03-01

    Full Text Available Hypertension is the most important modifiable risk factor for primary and secondary stroke prevention.All antihypertensive drugs are effective in primary prevention: the risk reduction for stroke is 30—42%. However, not all classes of drugs have the same effects: there is some indication that angiotensin receptor blockers may be superior to other classes of antihypertensive drugs in stroke prevention.Seventy-five percent of patients who present to hospital with acute stroke have elevated blood pressure within the first 24—48 hours. Extremes of systolic blood pressure (SBP increase the risk of death or dependency. The aim of treatment should be to achieve and maintain the SBP in the range 140—160 mmHg. However, fast and drastic blood pressure lowering can have adverse consequences.The PROGRESS trial of secondary prevention with perindopril + indapamide versus placebo + placebo showed a decrease in numbers of stroke recurrences in patients given both active antihypertensive agents, more impressive for cerebral haemorrhage.There were also indications that active treatment might decrease the development of post-stroke dementia.

  19. Knowledge of Stroke Risk Factors among Stroke Survivors in Nigeria

    OpenAIRE

    Grace Vincent-Onabajo; Taritei Moses

    2016-01-01

    Background. Knowledge of stroke risk factors is expected to reduce the incidence of stroke?whether first-ever or recurrent. This study examined knowledge of stroke risk factors and its determinants among stroke survivors. Methods. A cross-sectional survey of consenting stroke survivors at two physiotherapy facilities in Nigeria was carried out. Sociodemographic and clinical data were obtained and knowledge of stroke risk factors (defined as the ability to mention at least one correct risk fac...

  20. Stroke And Substance Abuse

    OpenAIRE

    A Chitsaz

    2017-01-01

    Introduction: stroke in recreational substance users can be an indirect complication, like endocarditis and cardio embolism in parenteral drug users. With some drug like cocaine, stroke appear to be the result of a direct effect. In young subjects without other risk factors provide persuasive evidence for causality . OPIATES: Heroine is the most abused opiate drug, which is administered by injection, by snorting or by smoking. Stroke affects heroin users by diverse mechanisms,. Injec...

  1. Periodismo virtual

    Directory of Open Access Journals (Sweden)

    Carlos Morales

    2015-01-01

    Full Text Available El periodismo virtual se produce en diarios que no ofrecen noticias (concebidas como versión o reflejo de la realidad sino que crean sus propias ficciones, especialmente en primeras planas. El autor del artículo señala que esto esta sucediendo en LA NACIÓN de San José de Costa Rica, diario premiado por la inefable Sociedad Interamericana de Prensa - SIP - y periódico económicamente más importante del país.

  2. Object and event recognition for stroke rehabilitation

    Science.gov (United States)

    Ghali, Ahmed; Cunningham, Andrew S.; Pridmore, Tony P.

    2003-06-01

    Stroke is a major cause of disability and health care expenditure around the world. Existing stroke rehabilitation methods can be effective but are costly and need to be improved. Even modest improvements in the effectiveness of rehabilitation techniques could produce large benefits in terms of quality of life. The work reported here is part of an ongoing effort to integrate virtual reality and machine vision technologies to produce innovative stroke rehabilitation methods. We describe a combined object recognition and event detection system that provides real time feedback to stroke patients performing everyday kitchen tasks necessary for independent living, e.g. making a cup of coffee. The image plane position of each object, including the patient"s hand, is monitored using histogram-based recognition methods. The relative positions of hand and objects are then reported to a task monitor that compares the patient"s actions against a model of the target task. A prototype system has been constructed and is currently undergoing technical and clinical evaluation.

  3. Stroke Prevention & Treatment: Diet & Nutrition

    Science.gov (United States)

    ... Prevention & Treatment: Diet & Nutrition Stroke Prevention & Treatment: Diet & Nutrition A healthy diet can reduce your risk for ... Treatment How does a stroke affect eating and nutrition? Stroke can devastate a person's nutritional health because ...

  4. Acute stroke imaging research roadmap

    NARCIS (Netherlands)

    Wintermark, Max; Albers, Gregory W.; Alexandrov, Andrei V.; Alger, Jeffry R.; Bammer, Roland; Baron, Jean-Claude; Davis, Stephen; Demaerschalk, Bart M.; Derdeyn, Colin P.; Donnan, Geoffrey A.; Eastwood, James D.; Fiebach, Jochen B.; Fisher, Marc; Furie, Karen L.; Goldmakher, Gregory V.; Hacke, Werner; Kidwell, Chelsea S.; Kloska, Stephan P.; Koehrmann, Martin; Koroshetz, Walter; Lee, Ting-Yim; Lees, Kennedy R.; Lev, Michael H.; Liebeskind, David S.; Ostergaard, Leif; Powers, William J.; Provenzale, James; Schellinger, Peter; Silbergleit, Robert; Sorensen, Alma Gregory; Wardlaw, Joanna; Warach, Steven

    The recent "Advanced Neuroimaging for Acute Stroke Treatment" meeting on September 7 and 8, 2007 in Washington DC, brought together stroke neurologists, neuroradiologists, emergency physicians, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke

  5. Risks for Heart Disease & Stroke

    Science.gov (United States)

    ... Prevent Risks for Heart Disease & Stroke Risks for Heart Disease & Stroke About 1.5 million heart attacks and ... can’t change some of your risks for heart disease and stroke, but you can manage many of ...

  6. Virtual Special Issue on Migration

    NARCIS (Netherlands)

    Jordan, Declan; Elhorst, Paul

    2016-01-01

    This editorial introduces a virtual special issue of Spatial Economic Analysis compiled to mark the keynote lecture at the 46th Annual Conference of the Regional Science Association InternationalBritish and Irish Section in Cornwall by Professor Jacques Poot of the National Institute of Demographic

  7. Acute pediatric stroke: contributors to institutional cost.

    Science.gov (United States)

    Turney, Colin M; Wang, Wei; Seiber, Eric; Lo, Warren

    2011-11-01

    Recent studies examined the overall cost of pediatric stroke, but there are little data regarding the sources of these costs. We examined an administrative database that collected charges from 24 US children's hospitals to determine the sources of costs for acute hospital care of stroke. We used International Classification of Diseases, 9th Revision codes to search the Pediatric Health Information System. From 2003 to 2009 there were 1667 patients who had a primary diagnosis of stroke, 703 of which were hemorrhagic and 964 were ischemic. Individual costs, excluding physician charges, were gathered under 7 categories that were ranked to determine which contributed the most to total cost. Individual costs were ranked within their categories. We analyzed costs based on stroke type. Total costs were adjusted using the US Consumer Price Index to compare increases with the rate of inflation. Median total cost for any stroke was $19,548 (interquartile range, $10,764-$40,721). The category "other/nursing" contributed the most to hospital costs followed by imaging, laboratory, and pharmacy. Brain MRI and CT contributed the most to imaging costs. Hemorrhagic strokes (median $24,843) were more expensive than ischemic strokes (median $16,954). Total cost increased from 2003 to 2009, but no overall annual trend emerged after controlling for gender, age, race, and hospital. This is the first in-depth analysis of cost for pediatric stroke care. The highest cost categories are potential targets for cost containment but are also crucial for effective diagnosis and treatment. Necessary yet prudent use of imaging technologies and inpatient stays may be strategies for cost containment.

  8. Upper limb treatment technigues for stroke survivors

    Directory of Open Access Journals (Sweden)

    Martyna Kornet

    2017-03-01

    It was considered that the most important elements of the treatment used in the rehabilitation of the paretic upper limb are: exercise matching the anti-spasm pattern, maintaining appropriate position for exercise that provide an approximation of the shoulder joint and the use of cross-facilitation. The study indicates that the treatment of a post stroke upper limb should be based on the: physiotherapy, kinesiotherapy and specific positioning - all of them corresponding to a given stage of the disease. The work also presents the most frequently used methods, especially highlighting: the Prorioceptive Neuromuscular Facilitation (PNF, Bobath, Brunnstrom, CIMT and OIT. It was also shown that in order to enhance the effects of a post-stroke upper limb rehabilitation, it should be extended by modern methods such as Mirror Therapy, Virtual Reality or Robot-assisted Therapy.

  9. Integrating a virtual agent into the real world

    OpenAIRE

    André, Elisabeth

    2007-01-01

    Integrating a virtual agent into the real world : the virtual anatomy assistant ritchie / K. Dorfmüller-Ulhaas ... - In: Intelligent virtual agents : 7th international conference, IVA 2007, Paris, France, September 17-19, 2007 ; proceedings / Catherine Pelachaud ... (eds.). - Berlin [u.a.] : Springer, 2007. - S. 211-224. - (Lecture notes in computer science ; 4722 : Lecture notes in artificial intelligence)

  10. Effect of white-matter lesions on the risk of periprocedural stroke after carotid artery stenting versus endarterectomy in the International Carotid Stenting Study (ICSS): a prespecified analysis of data from a randomised trial

    NARCIS (Netherlands)

    Ederle, J.; Davagnanam, I.; Worp, H.B. van der; Venables, G.S.; Lyrer, P.A.; Featherstone, R.L.; Brown, M.M.; Jager, H.R.; Leeuw, F.E. de; Schultze Kool, L.J.; Vliet, J.A. van der; et al.,

    2013-01-01

    BACKGROUND: Findings from randomised trials have shown a higher early risk of stroke after carotid artery stenting than after carotid endarterectomy. We assessed whether white-matter lesions affect the perioperative risk of stroke in patients treated with carotid artery stenting versus carotid

  11. Spontaneous ischaemic stroke in dogs

    DEFF Research Database (Denmark)

    Gredal, Hanne Birgit; Skerritt, G. C.; Gideon, P.

    2013-01-01

    Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms.......Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms....

  12. Body Mass Index and Stroke

    DEFF Research Database (Denmark)

    Andersen, Klaus Kaae; Olsen, Tom Skyhøj

    2013-01-01

    Although obesity is associated with excess mortality and morbidity, mortality is lower in obese than in normal weight stroke patients (the obesity paradox). Studies now indicate that obesity is not associated with increased risk of recurrent stroke in the years after first stroke. We studied...... the association between body mass index (BMI) and stroke patient's risk of having a history of previous stroke (recurrent stroke)....

  13. International

    International Nuclear Information System (INIS)

    Anon.

    1997-01-01

    This rubric reports on 10 short notes about international economical facts about nuclear power: Electricite de France (EdF) and its assistance and management contracts with Eastern Europe countries (Poland, Hungary, Bulgaria); Transnuclear Inc. company (a 100% Cogema daughter company) acquired the US Vectra Technologies company; the construction of the Khumo nuclear power plant in Northern Korea plays in favour of the reconciliation between Northern and Southern Korea; the delivery of two VVER 1000 Russian reactors to China; the enforcement of the cooperation agreement between Euratom and Argentina; Japan requested for the financing of a Russian fast breeder reactor; Russia has planned to sell a floating barge-type nuclear power plant to Indonesia; the control of the Swedish reactor vessels of Sydkraft AB company committed to Tractebel (Belgium); the renewal of the nuclear cooperation agreement between Swiss and USA; the call for bids from the Turkish TEAS electric power company for the building of the Akkuyu nuclear power plant answered by three candidates: Atomic Energy of Canada Limited (AECL), Westinghouse (US) and the French-German NPI company. (J.S.)

  14. Pengembangan Alat Bantu Rehabilitasi Pasien Pascastroke Berbasis Virtual Reality

    OpenAIRE

    Nugroho, Kristanto Agung; ., Herianto

    2016-01-01

    Stroke adalah penyakit yang mematikan karena dapat menyebabkan kecacatan dan kematian pada pasien. Makalah ini melaporkan penelitian membuat game virtual reality untuk rehabilitasi menggunakan sensor Kinect sebagai pengontrol. Pengembangan game dimulai dengan menentukan kebutuhan atribut konsumen dari wawancara dan observasi dengan fisioterapis dan pasien. Tes menggunakan metode thinking aloud, kuesioner, dan wawancara. Hasilnya adalah sebuah software game yang diberi judul Jaka Sembuh, game ...

  15. Ischemic Stroke: MedlinePlus Health Topic

    Science.gov (United States)

    ... Spanish Thrombolytic therapy (Medical Encyclopedia) Also in Spanish Topic Image MedlinePlus Email Updates Get Ischemic Stroke updates ... cardiogenic embolism Stroke - slideshow Thrombolytic therapy Related Health Topics Hemorrhagic Stroke Stroke Stroke Rehabilitation National Institutes of ...

  16. [A clinical case of young, oral combined contraceptive using women, heterozygous carrier of the Factor V (Leiden) which revealed thrombosis of the left internal jugular vein and brain ischemia with cerebral infarction and ischemic stroke].

    Science.gov (United States)

    Kovachev, S; Ramshev, K; Ramsheva, Z; Ivanov, A; Ganovska, A

    2013-01-01

    Thrombophilia is associated with increased risks of venous thrombosis in women taking oral contraceptive preparations. Universal thrombophilia screening in women prior to prescribing oral contraceptive preparations is not supported by current evidence. The case is presented of a 23 year-old women with a personal history of interruption and on the same day started with oral contraceptive (0.03 microg ethynil estradiol - 0.075 microg gestodene), which due on a 18 pill/day to acute headache, increasing vomiting and speaking defects. Physical/neurologic/gynecologic examinations observed a normal status. The MRI and CT revealed thrombosis of the left internal jugular vein and brain ischemia with cerebral infarction and ischemic stroke. The acute therapy of thrombotic findings was accompanied with many tests. The thrombophilia PCR-Real time - test finds heterozygous carrier of the Factor V (Leiden). This case shows the need of large prospective studies that should be undertaken to refine the risks and establish the associations of thrombophilias with venous thrombosis among contraceptive users. The key to a prompt diagnosis is to know the risk factors. The relative value of a thrombophilia screening programme before contraceptive using needs to be established.

  17. Trust and virtual worlds

    DEFF Research Database (Denmark)

    Ess, Charles; Thorseth, May

    2011-01-01

    We collect diverse philosophical analyses of the issues and problems clustering around trust online with specific attention to establishing trust in virtual environments. The book moves forward important discussions of how virtual worlds and virtuality are to be defined and understood; the role o...... by virtuality, such as virtual child pornography. The introduction further develops a philosophical anthropology, rooted in Kantian ethics, phenomenology, virtue ethics, and feminist perspectives, that grounds a specific approach to ethical issues in virtual environments....

  18. A conceptualisation of the relationship between virtual experience and cybernauts' satisfaction with virtual communities

    OpenAIRE

    Bouattour , Dorra; Debos , Franck; Abdellatif , Tarek

    2015-01-01

    International audience; In this research, we developed and tested an integrated model relating individuals' satisfaction with their experiential values in virtual communities. Using a realised factorial analysis and regression, we identified the factors that influence member satisfaction in virtual communities. Adopting Mathwick et al.'s (2001) concept of experiential value, we proposed a conceptualisation of a virtual experience that fits closely with the original nomological framework advoc...

  19. Realidad virtual y materialidad

    OpenAIRE

    Pérez Herranz, Fernando Miguel

    2009-01-01

    1. Fenomenología de partida: Real / Simbólico / Imaginario 2. Realidad 3. Virtual 3.1. Virtual / real / posible / probable 3.2. Los contextos de la realidad virtual A) REALIDAD VIRTUAL INMERSIVA B) REALIDAD VIRTUAL NO INMERSIVA C) REALIDAD VIRTUAL Y DIGITALIZACIÓN 3.3. Cruce virtual / real 3.4. Cuestiones filosóficas 4. Materialidad 5. Materialidad y descentramiento 5.1. Ejemplos de descentramiento en los contextos de Realidad Virtual A’) DUALISMO CARTESIANO, CUERPO Y «CIBORG » B’) EL ESPÍRIT...

  20. Diagnostic neuroimaging in stroke

    International Nuclear Information System (INIS)

    Jarenwattananon, A.; Khandji, A.; Brust, J.C.M.

    1988-01-01

    Since the development of cerebral angiography 60 years ago, there has been a proliferation of increasingly sophisticated, expensive, and, fortunately, safe imaging techniques for patients with cerebrovascular disease. In addition, occlusive and hemorrhagic stroke are now recognized as having a wide variety of possible causes. This chapter addresses the different imaging options available for particular kinds of stroke

  1. Relational Processing Following Stroke

    Science.gov (United States)

    Andrews, Glenda; Halford, Graeme S.; Shum, David; Maujean, Annick; Chappell, Mark; Birney, Damian

    2013-01-01

    The research examined relational processing following stroke. Stroke patients (14 with frontal, 30 with non-frontal lesions) and 41 matched controls completed four relational processing tasks: sentence comprehension, Latin square matrix completion, modified Dimensional Change Card Sorting, and n-back. Each task included items at two or three…

  2. Stroke (For Kids)

    Science.gov (United States)

    ... First Aid & Safety Doctors & Hospitals Videos Recipes for Kids Kids site Sitio para niños How the Body Works ... for Educators Search English Español Stroke KidsHealth / For Kids / Stroke What's in this article? What Happens During ...

  3. Realidad virtual

    OpenAIRE

    García García, Alberto Luis

    2000-01-01

    Las nuevas tecnologías, basadas en el mundo digital propuesto por la informática, están cambiando nuestra forma de entender el mundo, tanto desde el punto de vista sociocultural como económico. La realidad virtual se vale de códigos icónicos, y con ello se convierte en un paso más hacia la supresión de toda barrera linguística, para llegar a conseguir la gran comunidad global. Es necesario conocer en toda su extensión, una tecnología que está cambiando el modo de comunicarnos. Estos son, a gr...

  4. Virtual Reality and the Virtual Library.

    Science.gov (United States)

    Oppenheim, Charles

    1993-01-01

    Explains virtual reality, including proper and improper uses of the term, and suggests ways that libraries might be affected by it. Highlights include elements of virtual reality systems; possible virtual reality applications, including architecture, the chemical industry, transport planning, armed forces, and entertainment; and the virtual…

  5. From virtual environment to virtual community

    NARCIS (Netherlands)

    Nijholt, Antinus; Terano, Takao; Nishida, Toyoaki; Namatame, Akira; Tsumoto, Syusaku; Ohsawa, Yukido; Washio, Takashi

    2001-01-01

    We discuss a virtual reality theater environment and its transition to a virtual community by adding domain agents and by allowing multiple users to visit this environment. The environment has been built using VRML (Virtual Reality Modeling Language). We discuss how our ideas about this environment

  6. Astronomical Research Using Virtual Observatories

    Directory of Open Access Journals (Sweden)

    M Tanaka

    2010-01-01

    Full Text Available The Virtual Observatory (VO for Astronomy is a framework that empowers astronomical research by providing standard methods to find, access, and utilize astronomical data archives distributed around the world. VO projects in the world have been strenuously developing VO software tools and/or portal systems. Interoperability among VO projects has been achieved with the VO standard protocols defined by the International Virtual Observatory Alliance (IVOA. As a result, VO technologies are now used in obtaining astronomical research results from a huge amount of data. We describe typical examples of astronomical research enabled by the astronomical VO, and describe how the VO technologies are used in the research.

  7. Efficacy and safety of dabigatran compared with warfarin at different levels of international normalised ratio control for stroke prevention in atrial fibrillation: an analysis of the RE-LY trial.

    Science.gov (United States)

    Wallentin, Lars; Yusuf, Salim; Ezekowitz, Michael D; Alings, Marco; Flather, Marcus; Franzosi, Maria Grazia; Pais, Prem; Dans, Antonio; Eikelboom, John; Oldgren, Jonas; Pogue, Janice; Reilly, Paul A; Yang, Sean; Connolly, Stuart J

    2010-09-18

    Effectiveness and safety of warfarin is associated with the time in therapeutic range (TTR) with an international normalised ratio (INR) of 2·0-3·0. In the Randomised Evaluation of Long-term Anticoagulation Therapy (RE-LY) trial, dabigatran versus warfarin reduced both stroke and haemorrhage. We aimed to investigate the primary and secondary outcomes of the RE-LY trial in relation to each centre's mean TTR (cTTR) in the warfarin population. In the RE-LY trial, 18 113 patients at 951 sites were randomly assigned to 110 mg or 150 mg dabigatran twice daily versus warfarin dose adjusted to INR 2·0-3·0. Median follow-up was 2·0 years. For 18 024 patients at 906 sites, the cTTR was estimated by averaging TTR for individual warfarin-treated patients calculated by the Rosendaal method. We compared the outcomes of RE-LY across the three treatment groups within four groups defined by the quartiles of cTTR. RE-LY is registered with ClinicalTrials.gov, number NCT00262600. The quartiles of cTTR for patients in the warfarin group were: less than 57·1%, 57·1-65·5%, 65·5-72·6%, and greater than 72·6%. There were no significant interactions between cTTR and prevention of stroke and systemic embolism with either 110 mg dabigatran (interaction p=0·89) or 150 mg dabigatran (interaction p=0·20) versus warfarin. Neither were any significant interactions recorded with cTTR with regards to intracranial bleeding with 110 mg dabigatran (interaction p=0·71) or 150 mg dabigatran (interaction p=0·89) versus warfarin. There was a significant interaction between cTTR and major bleeding when comparing 150 mg dabigatran with warfarin (interaction p=0·03), with less bleeding events at lower cTTR but similar events at higher cTTR, whereas rates of major bleeding were lower with 110 mg dabigatran than with warfarin irrespective of cTTR. There were significant interactions between cTTR and effects of both 110 mg and 150 mg dabigatran versus warfarin on the composite of all

  8. Microsoft Virtualization Master Microsoft Server, Desktop, Application, and Presentation Virtualization

    CERN Document Server

    Olzak, Thomas; Boomer, Jason; Keefer, Robert M

    2010-01-01

    Microsoft Virtualization helps you understand and implement the latest virtualization strategies available with Microsoft products. This book focuses on: Server Virtualization, Desktop Virtualization, Application Virtualization, and Presentation Virtualization. Whether you are managing Hyper-V, implementing desktop virtualization, or even migrating virtual machines, this book is packed with coverage on all aspects of these processes. Written by a talented team of Microsoft MVPs, Microsoft Virtualization is the leading resource for a full installation, migration, or integration of virtual syste

  9. Design & control of a 3D stroke rehabilitation platform.

    Science.gov (United States)

    Cai, Z; Tong, D; Meadmore, K L; Freeman, C T; Hughes, A M; Rogers, E; Burridge, J H

    2011-01-01

    An upper limb stroke rehabilitation system is developed which combines electrical stimulation with mechanical arm support, to assist patients performing 3D reaching tasks in a virtual reality environment. The Stimulation Assistance through Iterative Learning (SAIL) platform applies electrical stimulation to two muscles in the arm using model-based control schemes which learn from previous trials of the task. This results in accurate movement which maximises the therapeutic effect of treatment. The principal components of the system are described and experimental results confirm its efficacy for clinical use in upper limb stroke rehabilitation. © 2011 IEEE

  10. Seven Capital Devices for the Future of Stroke Rehabilitation

    Directory of Open Access Journals (Sweden)

    M. Iosa

    2012-01-01

    Full Text Available Stroke is the leading cause of long-term disability for adults in industrialized societies. Rehabilitation’s efforts are tended to avoid long-term impairments, but, actually, the rehabilitative outcomes are still poor. Novel tools based on new technologies have been developed to improve the motor recovery. In this paper, we have taken into account seven promising technologies that can improve rehabilitation of patients with stroke in the early future: (1 robotic devices for lower and upper limb recovery, (2 brain computer interfaces, (3 noninvasive brain stimulators, (4 neuroprostheses, (5 wearable devices for quantitative human movement analysis, (6 virtual reality, and (7 tablet-pc used for neurorehabilitation.

  11. Post-stroke depression among stroke survivors attending two ...

    African Journals Online (AJOL)

    Background: The burden of stroke worldwide is increasing rapidly. There is paucity of data on post-stroke depression (PSD) among stroke survivors in Uganda, despite the high prevalence of PSD reported elsewhere. Methods: In a cross-sectional study, we assessed adult participants with confirmed first stroke with a ...

  12. Stroke mimic diagnoses presenting to a hyperacute stroke unit.

    Science.gov (United States)

    Dawson, Ang; Cloud, Geoffrey C; Pereira, Anthony C; Moynihan, Barry J

    2016-10-01

    Stroke services have been centralised in several countries in recent years. Diagnosing acute stroke is challenging and a high proportion of patients admitted to stroke units are diagnosed as a non-stroke condition (stroke mimics). This study aims to describe the stroke mimic patient group, including their impact on stroke services. We analysed routine clinical data from 2,305 consecutive admissions to a stroke unit at St George's Hospital, London. Mimic groupings were derived from 335 individual codes into 17 groupings. From 2,305 admissions, 555 stroke mimic diagnoses were identified (24.2%) and 72% of stroke mimics had at least one stroke risk factor. Common mimic diagnoses were headache, seizure and syncope. Medically unexplained symptoms and decompensation of underlying conditions were also common. Median length of stay was 1 day; a diagnosis of dementia (p=0.028) or needing MRI (p=0.006) was associated with a longer stay. Despite emergency department assessment by specialist clinicians and computed tomography brain, one in four suspected stroke patients admitted to hospital had a non-stroke diagnosis. Stroke mimics represent a heterogeneous patient group with significant impacts on stroke services. Co-location of stroke and acute neurology services may offer advantages where service reorganisation is being considered. © Royal College of Physicians 2016. All rights reserved.

  13. Developing a Virtual Book - Material for Virtual Learning Environments

    Directory of Open Access Journals (Sweden)

    Anne Karin Larsen

    2007-12-01

    Full Text Available This article describes the process of, and considerations taken when Virtual Learning Materials were developed for an international study in Comparative Social Work arranged by the VIRCLASS project. The steps taken and the elements included in the Virtual Book – A Guide to Social Work in Europe are presented in details to inform others who are planning to make virtual learning materials. Students from 11 countries in Europe participated, and their reception of this material and learning outcomes from using it are analysed and presented. Furthermore; the article discuss how the learning material contributes to students’ learning, how a common understanding of practice enhances knowledge-building and in what way audio-visual learning material can contribute to good learning in e-learning courses. The results are discussed in relation to theories about composite texts and community of inquiry, and outlines some challenges for e-teachers’ competences.

  14. Methodology of a population-based stroke and TIA incidence and outcomes study: the Auckland Regional Community Stroke Study (ARCOS IV) 2011-2012.

    Science.gov (United States)

    Krishnamurthi, Rita; Jones, Amy; Barber, P Alan; Barker-Collo, Suzanne; McPherson, Kathryn; Bennett, Derrick; Rush, Elaine; Suh, Flora; Starkey, Nicola; Theadom, Alice; Parag, Varsha; Rathnasabapathy, Yogini; Feigin, Valery L

    2014-01-01

    Stroke is a leading cause of death and disability worldwide. Stroke burden is immense as it leads to premature deaths, leaves survivors with ongoing disabilities, and has a major financial impact on the individual, their families, and the community. Reliable, high-quality evidence is needed on stroke risk factors, incidence, and outcomes to provide information on how best to reduce this burden. Population-based studies are regarded as the 'gold-standard' of measuring disease burden but are not common due to the logistical and financial challenges they present. The Auckland Regional Community Stroke Studies are among a few in the world that have been carried out at a population level and at regular intervals. The aim of the fourth Auckland Regional Community Stroke Studies IV is to examine the current measures of stroke incidence, prevalence, and outcomes as well the trends over four decades. This article describes the methodology of the Auckland Regional Community Stroke Studies IV with stroke and transient ischemic attacks cases registered over a 12-month period from March 1, 2011 to February 29, 2012. The methodology described may be used as a guide in order to design similar population-based stroke incidence and outcome studies in other countries and populations, thus facilitating the collection of most consistent and accurate stroke epidemiological data. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.

  15. Visual neglect following stroke: current concepts and future focus.

    Science.gov (United States)

    Ting, Darren S J; Pollock, Alex; Dutton, Gordon N; Doubal, Fergus N; Ting, Daniel S W; Thompson, Michelle; Dhillon, Baljean

    2011-01-01

    Visual neglect is a common, yet frequently overlooked, neurological disorder following stroke characterized by a deficit in attention and appreciation of stimuli on the contralesional side of the body. It has a profound functional impact on affected individuals. A assessment and management of this condition are hindered, however, by the lack of professional awareness and clinical guidelines. Recent evidence suggests that the underlying deficit in visual attention is due to a disrupted internalized representation of the outer world rather than a disorder of sensory inputs. Dysfunction of the cortical domains and white-matter tracts, as well as inter-hemispheric imbalance, have been implicated in the various manifestations of visual neglect. Optimal diagnosis requires careful history-taking from the patient, family, and friends, in addition to clinical assessment with the line bisection test, the star cancellation test, and the Catherine Bergego Scale. Early recognition and prompt rehabilitation employing a multidisciplinary approach is desirable. Although no treatment has been definitively shown to be of benefit, those with promise include prism adaptation, visual scanning therapy, and virtual reality-based techniques. Further high quality research to seek optimum short- and long-term rehabilitative strategies for visual neglect is required. Copyright © 2011 Elsevier Inc. All rights reserved.

  16. Stroke Risk Factors and Symptoms

    Science.gov (United States)

    ... » [ pdf, 433 kb ] Order Materials » Stroke Risk Factors and Symptoms Risk Factors for a Stroke Stroke prevention is still ... it. Treatment can delay complications that increase the risk of stroke. Transient ischemic attacks (TIAs). Seek help. ...

  17. Cognitive impairment and stroke in elderly patients

    Directory of Open Access Journals (Sweden)

    Lo Coco D

    2016-03-01

    Full Text Available Daniele Lo Coco,1 Gianluca Lopez,1 Salvatore Corrao,2,31Neurology and Stroke Unit, 2Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, 3Centre of Research for Effectiveness and Appropriateness in Medicine (C.R.E.A.M., Di.Bi.M.I.S., University of Palermo, Palermo, Italy Abstract: We reviewed current knowledge about the interaction between stroke and vascular risk factors and the development of cognitive impairment and dementia. Stroke is increasingly recognized as an important cause of cognitive problems and has been implicated in the development of both Alzheimer's disease and vascular dementia. The prevalence of cognitive impairment after stroke is high, and their combined effects significantly increase the cost of care and health resource utilization, with reflections on hospital readmissions and increased mortality rates. There is also substantial evidence that vascular risk factors (such as hypertension, diabetes, obesity, dyslipidemia, and tobacco smoking are independently associated with an increased risk of cognitive decline and dementia. Thus, a successful management of these factors, as well as optimal acute stroke management, might have a great impact on the development of cognitive impairment. Notwithstanding, the pathological link between cognitive impairment, stroke, and vascular risk factors is complex and still partially unclear so that further studies are needed to better elucidate the boundaries of this relationship. Many specific pharmacological treatments, including anticholinergic drugs and antihypertensive medications, and nonpharmacological approaches, such as diet, cognitive rehabilitation, and physical activity, have been studied for patients with vascular cognitive impairment, but the optimal care is still far away. Meanwhile, according to the most recent knowledge, optimal stroke care should also include cognitive assessment in the

  18. Dizziness in stroke

    Directory of Open Access Journals (Sweden)

    M. V. Zamergrad

    2015-01-01

    Full Text Available Differential diagnosis of new-onset acute vestibular vertigo is chiefly made between vestibular neuronitis and stroke. Dizziness in stroke is usually accompanied by other focal neurological symptoms of brainstem and cerebellar involvement. However, stroke may appear as isolated vestibular vertigo in some cases. An analysis of history data and the results of neurovestibular examination and brain magnetic resonance imaging allows stroke to be diagnosed in patients with acute isolated dizziness. The treatment of patients with stroke-induced dizziness involves a wide range of medications for the reduction of the degree of dizziness and unsteadiness and for the secondary prevention of stroke. Vestibular rehabilitation is an important component of treatment. The paper describes an observation of a patient with poorly controlled hypertension, who developed new-onset acute systemic dizziness. Vestibular neuronitis might be presumed to be a peripheral cause of vestibular disorders, by taking into account the absence of additional obvious neurological symptoms (such as pareses, defective sensation, diplopia, etc. and the nature of nystagmus. However, intention tremor in fingernose and heel-knee tests on the left side, a negative Halmagyi test, and results of Romberg’s test could suggest that stroke was a cause ofdizziness.

  19. A Virtual Class Calculus

    DEFF Research Database (Denmark)

    Ernst, Erik; Ostermann, Klaus; Cook, William Randall

    2006-01-01

    Virtual classes are class-valued attributes of objects. Like virtual methods, virtual classes are defined in an object's class and may be redefined within subclasses. They resemble inner classes, which are also defined within a class, but virtual classes are accessed through object instances...... model for virtual classes has been a long-standing open question. This paper presents a virtual class calculus, vc, that captures the essence of virtual classes in these full-fledged programming languages. The key contributions of the paper are a formalization of the dynamic and static semantics of vc...

  20. Hyponatremia in stroke

    Directory of Open Access Journals (Sweden)

    Sheikh Saleem

    2014-01-01

    Full Text Available Introduction: Hyponatremia is a common electrolyte disorder encountered in patients of neurological disorders which is usually either due to inappropriate secretion of Antidiuretic hormone (SIADH or cerebral salt wasting syndrome (CSWS. We conducted this study in a tertiary care hospital to determine the incidence and etiology of hyponatremia in patients of stroke admitted in the hospital. Materials and Methods: It was a prospective study done over a period of two years that included established cases of stroke diagnosed on the basis of clinical history, examination and neuroimaging. 1000 stoke patients were evaluated for hyponatremia (serum sodium <130 meq/l. The data was analysed using Chi-square test using SPSS (Statistical package for social science software. Results: Out of 1000 patients, 353 patients had hyponatremia. Out of this 353 patients, 238 (67% had SIADH and 115 (33% had CSWS. SIADH was seen in 83 patients who had ischemic stroke and 155 patients of hemorrhagic stroke. CSWS was found in 38 patients with ischemic stroke and 77 patients with hemorrhagic stroke. Statistical analysis revealed that hyponatremia significantly affects the outcome of stroke especially when it is due to CSWS rather than SIADH. Conclusion: Incidence of hyponatremia in our study population was 35%. In patients of hyponatremia 67% were having SIADH and 33% were having CSWS. Overall hyponatremia affected the outcome of stroke especially when caused by CSWS. Therefore close monitoring of serum sodium must be done in all patients who are admitted with stroke and efforts must be made to determine the cause of hyponatremia, in order to properly manage such patients thereby decreasing the mortality rate.

  1. Understanding Social Learning Behaviors via a Virtual Field Trip

    Directory of Open Access Journals (Sweden)

    Xin Bai

    2014-06-01

    Full Text Available This is a multidisciplinary study investigating how a virtual rather than face-to-face field trip can be conducted in a real-world setting and how students respond to such a social learning opportunity. Our participants followed a story of a stroke patient at her virtual home and in a virtual hospital via a teaching vignette. They were then given a new case and got on a virtual trip via a multiuser virtual environment. They played the roles of patients, relatives, doctors, or nurses, experiencing the emotional, physical, or social impacts those stakeholders may go through. Our study finds the overall participation of the Virtual Group is 50% more than the Text Group. Although the Virtual Group generates much more nodes in total, they focused much less on knowledge sharing and comparing than the Text Group (46 vs. 67, but more on other higher-level aspects of social interactions, such as knowledge discovery (57 vs. 42, co-construction (66 vs. 39, testing and modification (58 vs. 24 and application of newly constructed meaning (60 vs. 16. Analysis of students’ virtual field activities and in-depth discussions of important issues implied are included to help understand social learning behaviors during a virtual field trip. Sustainability of such systems is discussed.

  2. Virtual Trackballs Revisited

    DEFF Research Database (Denmark)

    Henriksen, Knud; Sporring, Jon; Hornbæk, Kasper

    2004-01-01

    reviews and provides a mathematical foundation for virtual trackballs. The first, but still popular, virtual trackball was described by Chen et al. [CHECK END OF SENTENCE]. We show that the virtual trackball by Chen et al. does not rotate the object along the intended great circular arc on the virtual...... trackball and we give a correction. Another popular virtual trackball is Shoemake's quaternion implementation [CHECK END OF SENTENCE], which we show to be a special case of the virtual trackball by Chen et al.. Shoemake extends the scope of the virtual trackball to the full screen. Unfortunately, Shoemake......'s virtual trackball is inhomogeneous and discontinuous with consequences for usability. Finally, we review Bell's virtual trackball [CHECK END OF SENTENCE] and discuss studies of the usability of virtual trackballs....

  3. Virtual cystoscopy.

    Science.gov (United States)

    Mohammed, Aza; Simpson, Adam; Zamora, Ignacio; Gilliland, Leslie

    2008-07-01

    Bladder cancer is a common problem facing urologists worldwide. The gold standard for its diagnosis and follow-up is the direct visualization of the tumor using conventional cystoscopy. Despite having high sensitivity and specificity for detecting bladder cancer, conventional cystoscopy is regarded as an invasive procedure which is associated with several complications. In addition, regular follow-up of patients with bladder cancer is a financial burden on the health system. With the progressive development in diagnostic imaging and medical computer software technologies, it was possible to generate virtual reality images to aid the clinician to inspect the interior of the bladder in real time. This technology is considered as a safe test for bladder cancer diagnosis and follow-up, and it is associated with cancer detection rates comparable with conventional cystoscopy. However, it is associated with some drawbacks that limit its use in routine clinical practice at the current time. In this paper, we review the development and clinical applications of this technology.

  4. Cost of stroke

    DEFF Research Database (Denmark)

    Jennum, Poul; Iversen, Helle K; Ibsen, Rikke

    2015-01-01

    . The attributable cost of direct net health care costs after the stroke (general practitioner services, hospital services, and medication) and indirect costs (loss of labor market income) were €10,720, €8,205 and €7,377 for patients, and €989, €1,544 and €1.645 for their partners, over and above that of controls......BACKGROUND: To estimate the direct and indirect costs of stroke in patients and their partners. DESCRIPTION: Direct and indirect costs were calculated using records from the Danish National Patient Registry from 93,047 ischemic, 26,012 hemorrhagic and 128,824 unspecified stroke patients...

  5. Clinical neurogenetics: stroke.

    Science.gov (United States)

    Rost, Natalia S

    2013-11-01

    Understanding the genetic architecture of cerebrovascular disease holds promise of novel stroke prevention strategies and therapeutics that are both safe and effective. Apart from a few single-gene disorders associated with cerebral ischemia or intracerebral hemorrhage, stroke is a complex genetic phenotype that requires careful ascertainment and robust association testing for discovery and validation analyses. The recently uncovered shared genetic contribution between clinically manifest stroke syndromes and closely related intermediate cerebrovascular phenotypes offers effective and efficient approaches to complex trait analysis. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. Determinan Penyakit Stroke

    Directory of Open Access Journals (Sweden)

    Woro Riyadina

    2013-02-01

    Full Text Available Penyakit stroke merupakan penyebab kematian dan kecacatan kronik yang paling tinggi pada kelompok umur diatas usia 45 tahun terbanyak di Indonesia. Tujuan penelitian ini untuk mengidentifikasi determinan utama yang berhubungan dengan penyakit stroke pada masyarakat di kelurahan Kebon Kalapa Bogor. Analisis lanjut terhadap 1.912 responden subset baseline data penelitian “Studi Kohort Faktor Risiko Penyakit Tidak Menular” Data dikumpulkan dengan metode wawancara pada penduduk tetap di kelurahan Kebon Kalapa, Kecamatan Bogor Tengah, Bogor tahun 2012. Diagnosis stroke berdasarkan anamnesis dan pemeriksaan dokter spesialis syaraf. Variabel independen meliputi karakteristik sosiodemografi, status kesehatan dan perilaku berisiko. Data dianalisis dengan uji regresi logistik ganda. Penyakit stroke ditemukan pada 49 (2,6% orang. Determinan utama stroke meliputi hipertensi (OR = 4,20; IK 95% = 2,20 – 8,03, penyakit jantung koroner (OR = 2,74; IK 95% = 1,51 – 4,99, diabetes melitus (OR = 2,89; IK 95% = 1,47 – 5,64, dan status ekonomi miskin (OR = 1,83 ; IK 95% = 1,03 – 3,33. Pencegahan penyakit stroke dilakukan dengan peningkatan edukasi (kampanye/penyuluhan melalui pengendalian faktor risiko utama yaitu hipertensi dan pencegahan terjadinya penyakit degeneratif lain yaitu penyakit jantung koroner dan diabetes melitus. Stroke disease is the leading cause of death and chronic disabi lity in most over the age of 45 years in Indonesia. The aim of study was to identify the major determinants of stroke disease in Kebon Kalapa community in Bogor. A deep analyze was conducted in 1.912 respondents based on the subset of baseline data “Risk Factors Cohort Study of Non Communicable Diseases.” Data was collected by interviews on Kebon Kalapa community, Bogor in 2012. Stroke diagnosis was determined by anamnesis and neu-rological examination with specialist. Independent variables were sociodemographic characteristics, health status and risk behavior

  7. The development of a virtual reality training programme for ophthalmology: repeatability and reproducibility (part of the International Forum for Ophthalmic Simulation Studies).

    Science.gov (United States)

    Saleh, G M; Theodoraki, K; Gillan, S; Sullivan, P; O'Sullivan, F; Hussain, B; Bunce, C; Athanasiadis, I

    2013-11-01

    To evaluate the variability of performance among novice ophthalmic trainees in a range of repeated tasks using the Eyesi virtual reality (VR) simulator. Eighteen subjects undertook three attempts of five cataract specific and generic three-dimensional tasks: continuous curvilinear capsulorhexis, cracking and chopping, cataract navigation, bimanual cataract training, anti-tremor. Scores for each attempt were out of a maximum of 100 points. A non-parametric test was used to analyse the data, where a P-value of <0.05 was considered statistically significant. Highly significant differences were found between the scores achieved in the first attempt and that during the second (P<0.0001) and third (P<0.0001) but not between the second and third attempt (P=0.65). There was no significant variability in the overall score between the users (P=0.1104) or in the difference between their highest and lowest score (P=0.3878). Highly significant differences between tasks were shown both in the overall score (P=0.0001) and in the difference between highest and lowest score (P=0.003). This study, which is the first to quantify reproducibility of performance in entry level trainees using a VR tool, demonstrated significant intra-novice variability. The cohort of subjects performed equally overall in the range of tasks (no inter-novice variability) but each showed that performance varies significantly with the complexity of the task when using this high-fidelity instrument.

  8. Stroke and sleep-disordered breathing: A relationship under construction.

    Science.gov (United States)

    Parra, Olga; Arboix, Adrià

    2016-02-16

    The association between sleep-disordered breathing (SDB) and cardiovascular risk has been the focus of attention in recent years. Sleep disorders are emerging risk factors for cardiovascular disease and have been related to the whole spectrum of stroke, including transient ischemic attack, ischemic cerebral infarction and intracerebral haemorrhage. It has been shown that lacunar stroke or lacunar infarctions affecting the internal capsule or the protuberance are associated with a higher frequency of SDB. Acute stroke patients with associated SDB have a worse prognosis and a higher mortality as compared to patients with first-ever stroke without SDB. Preliminary studies provide evidence of the usefulness of treatment with continuous positive airway pressure when SDB is present in stroke patients.

  9. Hypertension and experimental stroke therapies

    OpenAIRE

    O'Collins, Victoria E; Donnan, Geoffrey A; Macleod, Malcolm R; Howells, David W

    2013-01-01

    Hypertension is an established target for long-term stroke prevention but procedures for management of hypertension in acute stroke are less certain. Here, we analyze basic science data to examine the impact of hypertension on candidate stroke therapies and of anti-hypertensive treatments on stroke outcome. Methods: Data were pooled from 3,288 acute ischemic stroke experiments (47,899 animals) testing the effect of therapies on infarct size (published 1978–2010). Data were combined using meta...

  10. Virtual Web Services

    OpenAIRE

    Rykowski, Jarogniew

    2007-01-01

    In this paper we propose an application of software agents to provide Virtual Web Services. A Virtual Web Service is a linked collection of several real and/or virtual Web Services, and public and private agents, accessed by the user in the same way as a single real Web Service. A Virtual Web Service allows unrestricted comparison, information merging, pipelining, etc., of data coming from different sources and in different forms. Detailed architecture and functionality of a single Virtual We...

  11. Virtual button interface

    Science.gov (United States)

    Jones, J.S.

    1999-01-12

    An apparatus and method of issuing commands to a computer by a user interfacing with a virtual reality environment are disclosed. To issue a command, the user directs gaze at a virtual button within the virtual reality environment, causing a perceptible change in the virtual button, which then sends a command corresponding to the virtual button to the computer, optionally after a confirming action is performed by the user, such as depressing a thumb switch. 4 figs.

  12. Virtual reality in education

    OpenAIRE

    Minocha, Shailey; Tudor, Ana-Despina

    2017-01-01

    In this workshop-presentation, we described the evolution of virtual reality technologies and our research from 3D virtual worlds, 3D virtual environments built in gaming environments such as Unity 3D, 360-degree videos, and mobile virtual reality via Google Expeditions. For each of these four technologies, we discussed the affordances of the technologies and how they contribute towards learning and teaching. We outlined the significance of students being aware of the different virtual realit...

  13. Virtual reality - aesthetic consequences

    OpenAIRE

    Benda, Lubor

    2014-01-01

    In the present work we study aesthetic consequences of virtual reality. Exploring the fringe between fictional and virtual is one of the key goals, that will be achieved through etymologic and technologic definition of both fiction and virtual reality, fictional and virtual worlds. Both fiction and virtual reality will be then studied from aesthetic distance and aesthetic pleasure point of view. At the end, we will see the main difference as well as an common grounds between fiction and virtu...

  14. Identification Of Damages Of Tribological Associations In Crankshaft And Piston Systems Of Two-Stroke Internal Combustion Engines Used As Main Propulsion In Sea-Going Vessels And Proposal Of Probabilistic Description Of Loads As Causes Of These Damages

    Directory of Open Access Journals (Sweden)

    Girtler Jerzy

    2015-04-01

    Full Text Available The article discusses damages of essential tribological associations in crankshaft and piston systems of large power two-stroke engines used as main engines, which take place during transport tasks performed by those ships. Difficulties are named which make preventing those damages impossible, despite the fact that the technical state of engines of this type is identified with the aid of complex diagnostic systems making use of advanced computer technology. It is demonstrated that one of causes of the damages is the lack of research activities oriented on recognising random properties of the loads leading to those damages. A proposal is made for the loads acting at a given time t on tribological associations in crankshaft and piston systems of internal combustion engines used as main engines to be considered as random variables Qt. At the same time the loads examined within a given time interval tr ≤ t ≤ tz would be considered stochastic processes {Q(t: t ≥ 0}. Essential properties of the loads of the abovementioned tribological associations are named and explained by formulating hypotheses which need empirical verification. Interval estimation is proposed for estimating the expected value E(Qt of the load Qt acting at time t. A relation is indicated between the mechanical load and the thermal load acting on tribological associations in the ship main engine crankshaft and piston system. A suggestion is formulated that a stochastic form of the relation between these types of load is to be searched for, rather than statistic relation, and a proposal is made to measure the intensity (strength of the stochastic relation using the Czuprow’s convergence coefficient.

  15. Virtual goods recommendations in virtual worlds.

    Science.gov (United States)

    Chen, Kuan-Yu; Liao, Hsiu-Yu; Chen, Jyun-Hung; Liu, Duen-Ren

    2015-01-01

    Virtual worlds (VWs) are computer-simulated environments which allow users to create their own virtual character as an avatar. With the rapidly growing user volume in VWs, platform providers launch virtual goods in haste and stampede users to increase sales revenue. However, the rapidity of development incurs virtual unrelated items which will be difficult to remarket. It not only wastes virtual global companies' intelligence resources, but also makes it difficult for users to find suitable virtual goods fit for their virtual home in daily virtual life. In the VWs, users decorate their houses, visit others' homes, create families, host parties, and so forth. Users establish their social life circles through these activities. This research proposes a novel virtual goods recommendation method based on these social interactions. The contact strength and contact influence result from interactions with social neighbors and influence users' buying intention. Our research highlights the importance of social interactions in virtual goods recommendation. The experiment's data were retrieved from an online VW platform, and the results show that the proposed method, considering social interactions and social life circle, has better performance than existing recommendation methods.

  16. Virtual reality and planetary exploration

    Science.gov (United States)

    McGreevy, Michael W.

    Exploring planetary environments is central to NASA's missions and goals. A new computing technology called Virtual Reality has much to offer in support of planetary exploration. This technology augments and extends human presence within computer-generated and remote spatial environments. Historically, NASA has been a leader in many of the fundamental concepts and technologies that comprise Virtual Reality. Indeed, Ames Research Center has a central role in the development of this rapidly emerging approach to using computers. This ground breaking work has inspired researchers in academia, industry, and the military. Further, NASA's leadership in this technology has spun off new businesses, has caught the attention of the international business community, and has generated several years of positive international media coverage. In the future, Virtual Reality technology will enable greatly improved human-machine interactions for more productive planetary surface exploration. Perhaps more importantly, Virtual Reality technology will democratize the experience of planetary exploration and thereby broaden understanding of, and support for, this historic enterprise.

  17. Virtual reality and planetary exploration

    Science.gov (United States)

    Mcgreevy, Michael W.

    1992-01-01

    Exploring planetary environments is central to NASA's missions and goals. A new computing technology called Virtual Reality has much to offer in support of planetary exploration. This technology augments and extends human presence within computer-generated and remote spatial environments. Historically, NASA has been a leader in many of the fundamental concepts and technologies that comprise Virtual Reality. Indeed, Ames Research Center has a central role in the development of this rapidly emerging approach to using computers. This ground breaking work has inspired researchers in academia, industry, and the military. Further, NASA's leadership in this technology has spun off new businesses, has caught the attention of the international business community, and has generated several years of positive international media coverage. In the future, Virtual Reality technology will enable greatly improved human-machine interactions for more productive planetary surface exploration. Perhaps more importantly, Virtual Reality technology will democratize the experience of planetary exploration and thereby broaden understanding of, and support for, this historic enterprise.

  18. Young ischemic stroke in Tunisia: a multicentric study.

    Science.gov (United States)

    Kefi, Asma; Larbi, Thara; Abdallah, Meya; Ouni, Amira El; Bougacha, Neil; Bouslama, Kamel; Hamzaoui, Saloua; M'rad, Skander

    2017-04-01

    There is wanting data regarding young ischemic stroke in developing countries, especially in Tunisia. The purpose of this study was to investigate risk factors and etiologies of young ischemic stroke in Tunisian and make a comparison with previous reports. A total of 102 young ischemic stroke patients (15-45 years old) were admitted, between January 1996 and August 2007, to 11 departments of internal medicine in different Tunisian hospitals. The risk factors for stroke were documented and assessed. Diagnosis workup consisted of anamnesis, complete physical examination and extensive laboratory, radiologic, immunologic, neurologic and cardiologic examination. Stroke etiologies were classified according the Trial of ORG 10172 in acute stroke treatment. There were 42 men (41.2%) and 60 women (58.89%) with a mean age at onset of 35.7 years. As regards stroke subtype, large-artery atherosclerosis was diagnosed in 6.9% of cases, cardioembolism in 11.8%, small-vessel occlusion in 8.8%, other determined etiology in 37.3% and undetermined etiology in 35.3%. Concerning the traditional risk factors, smoking (31.4%), hypertension and diabetes mellitus (12.7% for each one) and a family history of stroke (10.8%) were the most common. The mean follow-up period was 30.5 months. In our study, traditional risk factors were not-so-uncommon in young adults with ischemic stroke suggesting that prevention can go through controlling these factors. Stroke of other determined etiology was the most common among our patients, so that a broad and detailed diagnostic workup is crucial to puzzle out the etiology for more and better stroke prevention.

  19. Stroke: Hope through Research

    Science.gov (United States)

    ... in a compromised state for several hours. With timely treatment these cells can be saved. The ischemic ... this research is the use of transcranial magnetic stimulation (TMS) in stroke rehabilitation. Some evidence suggests that ...

  20. Healthy Living after Stroke

    Science.gov (United States)

    ... Nutrition Cooking for Health Food for Thought: Heart-healthy Diet is Also Good For Your Brain Physical Activity Get Moving and Boost Your Brain Power Understanding Risky Conditions Converging Risk Factors for Stroke ...

  1. The "Know Stroke" Campaign

    Science.gov (United States)

    ... Issue Past Issues Special Section The "Know Stroke" Campaign Past Issues / Summer 2007 Table of Contents For ... Javascript on. NINDS is conducting a public awareness campaign across the United States to educate people about ...

  2. Recovering after stroke

    Science.gov (United States)

    ... urine from their body. To prevent skin or pressure sores: Clean up after incontinence Change position often and ... artery surgery - discharge Daily bowel care program Preventing pressure ulcers Stroke - discharge References Dobkin BH. Neurological rehabilitation In: ...

  3. National Stroke Association

    Science.gov (United States)

    ... partnership will offer free access to the RapidSOS Haven app for one year, providing individuals with enhanced ... of care to thrive after stroke. Make your tax-deductible donation today to support the growing needs ...

  4. Strokes (For Parents)

    Science.gov (United States)

    ... paralysis or weakness on one side of the body language or speech delays or changes, such as slurring ... uses many different types of therapy to help children recover from stroke. Outlook At this time, no ...

  5. Stroke - risk factors

    Science.gov (United States)

    ... oxygen. Brain cells can die, causing lasting damage. Risk factors are things that increase your chance of ... a disease or condition. This article discusses the risk factors for stroke and things you can do ...

  6. Epilepsy after stroke

    DEFF Research Database (Denmark)

    Olsen, T S; Høgenhaven, H; Thage, O

    1987-01-01

    Development of epilepsy was studied prospectively in a group of 77 consecutive stroke patients. Included were stroke patients less than 75 years old admitted within the first 3 days after the stroke. Excluded were patients with subarachnoid hemorrhage, vertebrobasilar stroke, and patients...... with other severe diseases. Cerebral angiography, CT, and EEG were performed in all patients. The patients were followed clinically for 2 to 4 years. Seven patients (9%) developed epilepsy. Of 23 patients with lesions involving the cortex, 6 (26%) developed epilepsy. Of 54 patients in whom the cortex...... was not involved, only 1 (2%) developed epilepsy. Patients with persisting paresis and cortical involvement seem to be at particularly high risk of developing epilepsy, as 50% of such patients (6 of 12) developed the disease....

  7. Enlarged perivascular spaces and cognitive impairment after stroke and transient ischemic attack.

    Science.gov (United States)

    Arba, Francesco; Quinn, Terence J; Hankey, Graeme J; Lees, Kennedy R; Wardlaw, Joanna M; Ali, Myzoon; Inzitari, Domenico

    2018-01-01

    Background Previous studies suggested that enlarged perivascular spaces are neuroimaging markers of cerebral small vessel disease. However, it is not clear whether enlarged perivascular spaces are associated with cognitive impairment. We aimed to determine the cross-sectional relationship between enlarged perivascular spaces and small vessel disease, and to investigate the relationship between enlarged perivascular spaces and subsequent cognitive impairment in patients with recent cerebral ischemic event. Methods Anonymized data were accessed from the virtual international stroke trial archive. We rated number of lacunes, white matter hyperintensities, brain atrophy, and enlarged perivascular spaces with validated scales on magnetic resonance brain images after the index stroke. We defined cognitive impairment as a mini mental state examination score of ≤26, recorded at one year post stroke. We examined the associations between enlarged perivascular spaces and clinical and imaging markers of small vessel disease at presentation and clinical evidence of cognitive impairment at one year using linear and logistic regression models. Results We analyzed data on 430 patients with mean (±SD) age 64.7 (±12.7) years, 276 (64%) males. In linear regression analysis, age (β = 0.24; p cognitive impairment at one year after adjusting for clinical confounders (OR = 1.72, 95% CI = 1.22-2.42) and for clinical and imaging confounders (OR = 1.54; 95% CI = 1.03-2.31). Conclusions Our data show that in patients with ischemic cerebral events, enlarged perivascular spaces are cross-sectionally associated with age, hypertension, and white matter hyperintensities and suggest that enlarged perivascular spaces in the basal ganglia are associated with cognitive impairment after one year.

  8. STROKE IN YOUNG ADULTS: A RETROSPECTIVE STUDY OF 68 CASES

    Directory of Open Access Journals (Sweden)

    M. H. Harirchian

    2006-06-01

    Full Text Available Numerous etiologies are responsible for cases of stroke in young adults. This study reviews the causes of two types of stroke (ischemic and intracerebral hemorrhage in young adults aged 15 to 40years, admitted to our center (a tertiary care center from 1997 to 2002. The purpose of this study is to determine the relative frequency of causes of stroke in young adults and compare this with published data in the literature. Using the codes 46.0 to 46.8 of the International Classification of Diseases- 10th Edition (ICD-10, cases were identified from the records of the stroke patients admitted in Imam Khomeini Hospital and the data were collected from their files using a comprehensive questionnaire. Forty-two cases of ischemic stroke (62% and 26 cases of intracerebral hemorrhage (38% were identified. The leading cause of ischemic stroke was cardioembolism (38.1%, followed by atherosclerosis in 5 cases (11.9%. Among cardiac causes infarction was attributable to consequences of rheumatic heart disease in 8 cases. In 3 cases a cessation or decrease in dose of warfarin was followed directly by an ischemic stroke. The most leading cause of intracerebral hemorrhage was hypertension (30.8%. Other causes were anticoagulant therapy, intratumoral hemorrhage, aplastic anemia, leukemia, arteriovenous malformations, and chronic active hepatitis. In conclusion, cardioembolism and hypertension were the most leading causes of ischemic and hemorrhagic stroke in young adults admitted in our hospital.

  9. Design and rationale for examining neuroimaging genetics in ischemic stroke

    Science.gov (United States)

    Giese, Anne-Katrin; Schirmer, Markus D.; Donahue, Kathleen L.; Cloonan, Lisa; Irie, Robert; Winzeck, Stefan; Bouts, Mark J.R.J.; McIntosh, Elissa C.; Mocking, Steven J.; Dalca, Adrian V.; Sridharan, Ramesh; Xu, Huichun; Frid, Petrea; Giralt-Steinhauer, Eva; Holmegaard, Lukas; Roquer, Jaume; Wasselius, Johan; Cole, John W.; McArdle, Patrick F.; Broderick, Joseph P.; Jimenez-Conde, Jordi; Jern, Christina; Kissela, Brett M.; Kleindorfer, Dawn O.; Lemmens, Robin; Lindgren, Arne; Meschia, James F.; Rundek, Tatjana; Sacco, Ralph L.; Schmidt, Reinhold; Sharma, Pankaj; Slowik, Agnieszka; Thijs, Vincent; Woo, Daniel; Worrall, Bradford B.; Kittner, Steven J.; Mitchell, Braxton D.; Rosand, Jonathan; Golland, Polina; Wu, Ona

    2017-01-01

    Objective: To describe the design and rationale for the genetic analysis of acute and chronic cerebrovascular neuroimaging phenotypes detected on clinical MRI in patients with acute ischemic stroke (AIS) within the scope of the MRI–GENetics Interface Exploration (MRI-GENIE) study. Methods: MRI-GENIE capitalizes on the existing infrastructure of the Stroke Genetics Network (SiGN). In total, 12 international SiGN sites contributed MRIs of 3,301 patients with AIS. Detailed clinical phenotyping with the web-based Causative Classification of Stroke (CCS) system and genome-wide genotyping data were available for all participants. Neuroimaging analyses include the manual and automated assessments of established MRI markers. A high-throughput MRI analysis pipeline for the automated assessment of cerebrovascular lesions on clinical scans will be developed in a subset of scans for both acute and chronic lesions, validated against gold standard, and applied to all available scans. The extracted neuroimaging phenotypes will improve characterization of acute and chronic cerebrovascular lesions in ischemic stroke, including CCS subtypes, and their effect on functional outcomes after stroke. Moreover, genetic testing will uncover variants associated with acute and chronic MRI manifestations of cerebrovascular disease. Conclusions: The MRI-GENIE study aims to develop, validate, and distribute the MRI analysis platform for scans acquired as part of clinical care for patients with AIS, which will lead to (1) novel genetic discoveries in ischemic stroke, (2) strategies for personalized stroke risk assessment, and (3) personalized stroke outcome assessment. PMID:28852707

  10. Design and Qualitative Evaluation of Tactile Devices for Stroke Rehabilitation

    OpenAIRE

    Merrett, Geoff V; Metcalf, Cheryl D; Zheng, Deyi; Cunningham, Sarah; Barrow, Stuart; Demain, Sara H

    2011-01-01

    Rehabilitation environments combining virtual reality with everyday motor tasks can promote recovery from neurological illness, such as stroke. Tactile devices, providing physical stimulation to the skin, may improve motor retraining. While many tactile devices have been reported, there is a distinct paucity of studies evaluating how they are perceived. This multidisciplinary research has investigated three tactile devices (vibration motors, a motor-driven ‘squeezer’, and shape memory alloys)...

  11. Research progress of new technologies in stroke rehabilitation

    Directory of Open Access Journals (Sweden)

    Lin MENG

    2017-03-01

    Full Text Available Survivors of stroke commonly experience a different range of dysfunction, and recovery can be slow and incomplete, which lead to a serious and long-term impact on patients themselves and their families. Although the treatment of stroke patients relies mainly on rehabilitation intervention, but the rehabilitation needs of discharged patients are not fully met due to lots of restrictions, such as the lack of professional rehabilitation services, the difficulty and inconvenience in transportation from home to hospital, therefore their prognosis of rehabilitation are affected. At present a number of new rehabilitation technologies, including telerehabilitation (TR, virtual reality (VR, robotics, electronic textiles (E-textiles, etc., are coming into being and may solve these problems. This article tries to discuss the research progress of these new rehabilitation technologies, and provide a new perspective for the rehabilitation intervention of stroke patients. DOI: 10.3969/j.issn.1672-6731.2017.03.003

  12. Autopsy approach to stroke.

    Science.gov (United States)

    Love, Seth

    2011-02-01

    Stroke is a major cause of morbidity and mortality but the brain and other relevant tissues are often examined only cursorily when stroke patients come to autopsy. The pathological findings and clinical implications vary according to the type of stroke and its location and cause. Large ischaemic strokes are usually associated with atherosclerosis of extracranial or major intracranial arteries but can be caused by dissection. Most small cerebral infarcts are caused by arteriosclerosis or, in the elderly, cerebral amyloid angiopathy (CAA). However, vasculitides and coagulopathies can cause a range of different patterns of ischaemic (and, occasionally, haemorrhagic) stroke. Global brain ischaemia, caused by severe hypotension or raised intracranial pressure, produces damage that is accentuated in certain regions and neuronal populations and may be confused with hypoglycaemic injury. The main cause of subarachnoid haemorrhage is a ruptured berry aneurysm but CAA, arteriovenous malformations and infective aneurysms are occasionally responsible. These can also cause parenchymal brain haemorrhage, although this most often complicates hypertensive small vessel disease. Sometimes the haemorrhage arises from a neoplasm. Performing an adequate autopsy in stroke requires proper preparation, awareness of the likely pathological processes, familiarity with intracranial vascular anatomy, careful gross examination and dissection, and appropriate use of histology. © 2010 Blackwell Publishing Limited.

  13. BCI and FES Based Therapy for Stroke Rehabilitation Using VR Facilities

    Directory of Open Access Journals (Sweden)

    Robert Gabriel Lupu

    2018-01-01

    Full Text Available In recent years, the assistive technologies and stroke rehabilitation methods have been empowered by the use of virtual reality environments and the facilities offered by brain computer interface systems and functional electrical stimulators. In this paper, a therapy system for stroke rehabilitation based on these revolutionary techniques is presented. Using a virtual reality Oculus Rift device, the proposed system ushers the patient in a virtual scenario where a virtual therapist coordinates the exercises aimed at restoring brain function. The electrical stimulator helps the patient to perform rehabilitation exercises and the brain computer interface system and an electrooculography device are used to determine if the exercises are executed properly. Laboratory tests on healthy people led to system validation from technical point of view. The clinical tests are in progress, but the preliminary results of the clinical tests have highlighted the good satisfaction degree of patients, the quick accommodation with the proposed therapy, and rapid progress for each user rehabilitation.

  14. Parvovirus B19 Infection in Children With Arterial Ischemic Stroke.

    Science.gov (United States)

    Fullerton, Heather J; Luna, Jorge M; Wintermark, Max; Hills, Nancy K; Tokarz, Rafal; Li, Ying; Glaser, Carol; DeVeber, Gabrielle A; Lipkin, W Ian; Elkind, Mitchell S V

    2017-10-01

    Case-control studies suggest that acute infection transiently increases the risk of childhood arterial ischemic stroke. We hypothesized that an unbiased pathogen discovery approach utilizing MassTag-polymerase chain reaction would identify pathogens in the blood of childhood arterial ischemic stroke cases. The multicenter international VIPS study (Vascular Effects of Infection in Pediatric Stroke) enrolled arterial ischemic stroke cases, and stroke-free controls, aged 29 days through 18 years. Parental interview included questions on recent infections. In this pilot study, we used MassTag-polymerase chain reaction to test the plasma of the first 161 cases and 34 controls enrolled for a panel of 28 common bacterial and viral pathogens. Pathogen DNA was detected in no controls and 14 cases (8.7%): parvovirus B19 (n=10), herpesvirus 6 (n=2), adenovirus (n=1), and rhinovirus 6C (n=1). Parvovirus B19 infection was confirmed by serologies in all 10; infection was subclinical in 8. Four cases with parvovirus B19 had underlying congenital heart disease, whereas another 5 had a distinct arteriopathy involving a long-segment stenosis of the distal internal carotid and proximal middle cerebral arteries. Using MassTag-polymerase chain reaction, we detected parvovirus B19-a virus known to infect erythrocytes and endothelial cells-in some cases of childhood arterial ischemic stroke. This approach can generate new, testable hypotheses about childhood stroke pathogenesis. © 2017 American Heart Association, Inc.

  15. Nursing care for stroke patients

    DEFF Research Database (Denmark)

    Tulek, Zeliha; Poulsen, Ingrid; Gillis, Katrin

    2018-01-01

    AIMS AND OBJECTIVES: To conduct a survey of the clinical nursing practice in European countries in accordance with the European Stroke Strategies (ESS) 2006, and to examine to what extent the ESS have been implemented in stroke care nursing in Europe. BACKGROUND: Stroke is a leading cause of death...... comprising 61 questions based on the ESS and scientific evidence in nursing practice was distributed to representatives of the European Association of Neuroscience Nurses, who sent the questionnaire to nurses active in stroke care. The questionnaire covered the following areas of stroke care: Organization...... of stroke services, Management of acute stroke and prevention including basic care and nursing, and Secondary prevention. RESULTS: Ninety-two nurses in stroke care in 11 European countries participated in the survey. Within the first 48 hours after stroke onset, 95% monitor patients regularly, 94% start...

  16. Ten years of the Spanish Virtual Observatory

    Science.gov (United States)

    Solano, E.

    2015-05-01

    The main objective of the Virtual Observatory (VO) is to guarantee an easy and efficient access and analysis of the information hosted in astronomical archives. The Spanish Virtual Observatory (SVO) is a project that was born in 2004 with the goal of promoting and coordinating the VO-related activities at national level. SVO is also the national contact point for the international VO initiatives, in particular the International Virtual Observatory Alliance (IVOA) and the Euro-VO project. The project, led by Centro de Astrobiología (INTA-CSIC), is structured around four major topics: a) VO compliance of astronomical archives, b) VO-science, c) VO- and data mining-tools, and d) Education and outreach. In this paper I will describe the most important results obtained by the Spanish Virtual Observatory in its first ten years of life as well as the future lines of work.

  17. Asymetric Telecollaboration in Virtual Reality

    OpenAIRE

    PORSSUT, Thibault; CHARDONNET, Jean-Rémy

    2017-01-01

    International audience; We present a first study where we combine two asymetric virtual reality systems for telecollaboration purposes: a CAVE system and a head-mounted display (HMD), using a server-client type architecture. Experiments on a puzzle game in limited time, alone and in collaboration, show that combining asymetric systems reduces cognitive load. Moreover, the participants reported preferring working in collaboration and showed to be more efficient in collaboration. These results ...

  18. Stroke risk perception among participants of a stroke awareness campaign

    Science.gov (United States)

    Kraywinkel, Klaus; Heidrich, Jan; Heuschmann, Peter U; Wagner, Markus; Berger, Klaus

    2007-01-01

    Background Subjective risk factor perception is an important component of the motivation to change unhealthy life styles. While prior studies assessed cardiovascular risk factor knowledge, little is known about determinants of the individual perception of stroke risk. Methods Survey by mailed questionnaire among 1483 participants of a prior public stroke campaign in Germany. Participants had been informed about their individual stroke risk based on the Framingham stroke risk score. Stroke risk factor knowledge, perception of lifetime stroke risk and risk factor status were included in the questionnaire, and the determinants of good risk factor knowledge and high stroke risk perception were identified using logistic regression models. Results Overall stroke risk factor knowledge was good with 67–96% of the participants recognizing established risk factors. The two exceptions were diabetes (recognized by 49%) and myocardial infarction (57%). Knowledge of a specific factor was superior among those affected by it. 13% of all participants considered themselves of having a high stroke risk, 55% indicated a moderate risk. All major risk factors contributed significantly to the perception of being at high stroke risk, but the effects of age, sex and education were non-significant. Poor self-rated health was additionally associated with high individual stroke risk perception. Conclusion Stroke risk factor knowledge was high in this study. The self perception of an increased stroke risk was associated with established risk factors as well as low perception of general health. PMID:17371603

  19. Relearning the Basics: Rehabilitation after a Stroke

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Stroke Rehabilitation Relearning the Basics: Rehabilitation After a Stroke Past ... to help them recover successfully. What is post-stroke rehabilitation? Rehab helps stroke survivors relearn skills lost to ...

  20. Death caused by heat stroke: Case report

    Directory of Open Access Journals (Sweden)

    Savić Slobodan

    2014-01-01

    Full Text Available Introduction. Heat stroke is the most dangerous among numerous disorders caused by elevated environmental temperature. It is characterized by an increased body temperature of over 40°C, the dysfunction of the central nervous system and the development of multiple organ failure. The aim of this paper was to highlight problems in the clinical and post-mortal diagnosis of fatal heat stroke. Case Outline. A 20-year-old male was found unconscious on the street; on admission at the Emergency Center, Clinical Center of Serbia, Belgrade, he was in a coma. The body temperature of 40°C was maintained despite the applied therapy, meningeal signs were negative, tachycardia with gallop rhythm, hypotension, bleeding from the nose and mouth, and presence of skin bruises. Laboratory findings: highly elevated LDH and creatine kinase, elevated serum creatinine, AST, and signs of DIC. Lethal outcome occurred 6 hours after admission, and the case remained clinically unsolved. Autopsy showed signs of hemorrhagic diathesis, brain and pulmonary edema, and microscopic examination revealed general congestion, internal bleeding in various organs, cerebral edema, massive blood aspiration and pulmonary edema. Toxicological and bacteriological examinations were negative. Based on these findings and subsequently obtained data on the conditions at the workplace where the young man had a part-time job, it was concluded that the violent death was caused by heat stroke. Conclusion. Since heat stroke is associated with a high mortality rate and high incidence of serious and permanent organ damage in survivors, it is important to make the diagnosis of heat stroke as quickly as possible and apply appropriate treatment. Misdiagnosis of heat stroke, and consequently inadequate treatment, with a potential fatal outcome for the patient, can be the reason for blaming doctors for the legal offense of medical malpractice in failing to administer first aid.

  1. Stroke subtyping for genetic association studies? A comparison of the CCS and TOAST classifications.

    Science.gov (United States)

    Lanfranconi, Silvia; Markus, Hugh S

    2013-12-01

    Classification of Stroke system reduced the proportion of patients classified to undetermined subtypes. The excellent inter-rater reproducibility and web-based semiautomated nature make Causative Classification of Stroke system suitable for multicenter studies, but the benefit of reclassifying cases already classified using the Trial of ORG 10172 in Acute Stroke Treatment system on existing databases is likely to be small. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

  2. Code stroke in Asturias.

    Science.gov (United States)

    Benavente, L; Villanueva, M J; Vega, P; Casado, I; Vidal, J A; Castaño, B; Amorín, M; de la Vega, V; Santos, H; Trigo, A; Gómez, M B; Larrosa, D; Temprano, T; González, M; Murias, E; Calleja, S

    2016-04-01

    Intravenous thrombolysis with alteplase is an effective treatment for ischaemic stroke when applied during the first 4.5 hours, but less than 15% of patients have access to this technique. Mechanical thrombectomy is more frequently able to recanalise proximal occlusions in large vessels, but the infrastructure it requires makes it even less available. We describe the implementation of code stroke in Asturias, as well as the process of adapting various existing resources for urgent stroke care in the region. By considering these resources, and the demographic and geographic circumstances of our region, we examine ways of reorganising the code stroke protocol that would optimise treatment times and provide the most appropriate treatment for each patient. We distributed the 8 health districts in Asturias so as to permit referral of candidates for reperfusion therapies to either of the 2 hospitals with 24-hour stroke units and on-call neurologists and providing IV fibrinolysis. Hospitals were assigned according to proximity and stroke severity; the most severe cases were immediately referred to the hospital with on-call interventional neurology care. Patient triage was provided by pre-hospital emergency services according to the NIHSS score. Modifications to code stroke in Asturias have allowed us to apply reperfusion therapies with good results, while emphasising equitable care and managing the severity-time ratio to offer the best and safest treatment for each patient as soon as possible. Copyright © 2015 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  3. Knee posture during gait and global functioning post-stroke: a theoretical ICF framework using current measures in stroke rehabilitation

    OpenAIRE

    Neves Rosa, Marlene Cristina; Marques, Alda; Demain, Sara; Metcalf, Cheryl D.

    2015-01-01

    Purpose: To characterise the global functioning post-stroke in patients with normal knee posture (NKP) and abnormal knee posture (AKP) during loading-response. Methods: 35 people, 6 months post-stroke. with NKP and AKP were identified and assessed using clinical measures classified into the corresponding International Classification of Functioning, Disability and Health (ICF) domains: weight function (body mass index); muscle power (knee isometric strength); muscle tone (Modified Ashworth Sca...

  4. Virtual, augmented reality and serious games for healthcare

    CERN Document Server

    Jain, Lakhmi; Anderson, Paul

    2014-01-01

    There is a tremendous interest among researchers for the development of virtual, augmented reality and games technologies due to their widespread applications in medicine and healthcare. To date the major applications of these technologies include medical simulation, telemedicine, medical and healthcare training, pain control, visualisation aid for surgery, rehabilitation in cases such as stroke, phobia, and trauma therapies. Many recent studies have identified the benefits of using Virtual Reality, Augmented Reality, or serious games in a variety of medical applications.   This research volume on Virtual, Augmented Reality and Serious Games for Healthcare 1 offers an insightful introduction to the theories, development and applications of virtual, augmented reality and digital games technologies in medical and clinical settings and healthcare in general. It is divided into six sections: section one presents a selection of applications in medical education and healthcare management; Section two relates to th...

  5. Risk Factors and Stroke Characteristic in Patients with Postoperative Strokes.

    Science.gov (United States)

    Dong, Yi; Cao, Wenjie; Cheng, Xin; Fang, Kun; Zhang, Xiaolong; Gu, Yuxiang; Leng, Bing; Dong, Qiang

    2017-07-01

    Intravenous thrombolysis and intra-arterial thrombectomy are now the standard therapies for patients with acute ischemic stroke. In-house strokes have often been overlooked even at stroke centers and there is no consensus on how they should be managed. Perioperative stroke happens rather frequently but treatment protocol is lacking, In China, the issue of in-house strokes has not been explored. The aim of this study is to explore the current management of in-house stroke and identify the common risk factors associated with perioperative strokes. Altogether, 51,841 patients were admitted to a tertiary hospital in Shanghai and the records of those who had a neurological consult for stroke were reviewed. Their demographics, clinical characteristics, in-hospital complications and operations, and management plans were prospectively studied. Routine laboratory test results and risk factors of these patients were analyzed by multiple logistic regression model. From January 1, 2015, to December 31, 2015, over 1800 patients had neurological consultations. Among these patients, 37 had an in-house stroke and 20 had more severe stroke during the postoperative period. Compared to in-house stroke patients without a procedure or operation, leukocytosis and elevated fasting glucose levels were more common in perioperative strokes. In multiple logistic regression model, perioperative strokes were more likely related to large vessel occlusion. Patients with perioperative strokes had different risk factors and severity from other in-house strokes. For these patients, obtaining a neurological consultation prior to surgery may be appropriate in order to evaluate the risk of perioperative stroke. Copyright © 2017. Published by Elsevier Inc.

  6. Child-Mediated Stroke Communication: findings from Hip Hop Stroke.

    Science.gov (United States)

    Williams, Olajide; DeSorbo, Alexandra; Noble, James; Gerin, William

    2012-01-01

    Low thrombolysis rates for acute ischemic stroke are linked to delays in seeking immediate treatment due to low public stroke awareness. We aimed to assess whether "Child-Mediated Stroke Communication" could improve stroke literacy of parents of children enrolled in a school-based stroke literacy program called Hip Hop Stroke. Parents of children aged 9 to 12 years from 2 public schools in Harlem, New York City, were recruited to participate in stroke literacy questionnaires before and after their child's participation in Hip Hop Stroke, a novel Child-Mediated Stroke Communication intervention delivered in school auditoriums. Parental recall of stroke information communicated through their child was assessed 1-week after the intervention. Fifth and sixth grade students (n=182) were enrolled into Hip Hop Stroke. One hundred two parents were approached in person to participate; 75 opted to participate and 71 completed both the pretest and post-test (74% response rate and 95% retention rate). Parental stroke literacy improved after the program; before the program, 3 parents of 75 (3.9%) were able to identify the 5 cardinal stroke symptoms, distracting symptom (chest pains), and had an urgent action plan (calling 911) compared with 21 of 71 parents (29.6%) postintervention (P<0.001). The FAST mnemonic was known by 2 (2.7%) of participants before the program versus 29 (41%) after program completion (P<0.001). Knowledge of stroke signs and symptoms remains low among residents of this high-risk population. The use of Child-Mediated Stroke Communication suggests that school children aged 9 to 12 years may be effective conduits of critical stroke knowledge to their parents.

  7. Water Footprint and Virtual Water Trade of Brazil

    Directory of Open Access Journals (Sweden)

    Vicente de Paulo R. da Silva

    2016-11-01

    Full Text Available Freshwater scarcity has increased at an alarming rate worldwide; improved water management plays a vital role in increasing food production and security. This study aims to determine the water footprint of Brazil’s national food consumption, the virtual water flows associated with international trade in the main agricultural commodities, as well as water scarcity, water self-sufficiency and water dependency per Brazilian region. While previous country studies on water footprints and virtual water trade focused on virtual water importers or water-scarce countries, this is the first study to concentrate on a water-abundant virtual water-exporting country. Besides, it is the first study establishing international virtual water trade balances per state, which is relevant given the fact that water scarcity varies across states within the country, so the origin of virtual water exports matters. The results show that the average water footprint of Brazilian food consumption is 1619 m3/person/year. Beef contributes most (21% to this total. We find a net virtual water export of 54.8 billion m3/year, mainly to Europe, which imports 41% of the gross amount of the virtual water exported from Brazil. The northeast, the region with the highest water scarcity, has a net import of virtual water. The southeast, next in terms of water scarcity, shows large virtual water exports, mainly related to the export of sugar. The north, which has the most water, does not show a high virtual water export rate.

  8. Does national expenditure on research and development influence stroke outcomes?

    Science.gov (United States)

    Kim, Young Dae; Jung, Yo Han; Norrving, Bo; Ovbiagele, Bruce; Saposnik, Gustavo

    2017-10-01

    Background Expenditure on research and development is a macroeconomic indicator representative of national investment. International organizations use this indicator to compare international research and development activities. Aim We investigated whether differences in expenditures on research and development at the country level may influence the incidence of stroke and stroke mortality. Methods We compared stroke metrics with absolute amount of gross domestic expenditure on R&D (GERD) per-capita adjusted for purchasing power parity (aGERD) and relative amount of GERD as percent of gross domestic product (rGERD). Sources included official data from the UNESCO, the World Health Organization, the World Bank, and population-based studies. We used correlation analysis and multivariable linear regression modeling. Results Overall, data on stroke mortality rate and GERD were available from 66 countries for two periods (2002 and 2008). Age-standardized stroke mortality rate was associated with aGERD (r = -0.708 in 2002 and r = -0.730 in 2008) or rGERD (r = -0.545 in 2002 and r = -0.657 in 2008) (all p < 0.001). Multivariable analysis showed a lower aGERD and rGERD were independently and inversely associated with higher stroke mortality (all p < 0.05). The estimated prevalence of hypertension, diabetes, or obesity was higher in countries with lower aGERD. The analysis of 27 population-based studies showed consistent inverse associations between aGERD or rGERD and incident risk of stroke and 30-day case fatality. Conclusions There is higher stroke mortality among countries with lower expenditures in research and development. While this study does not prove causality, it suggests a potential area to focus efforts to improve global stroke outcomes.

  9. Virtual Trackballs Revisited

    OpenAIRE

    Henriksen, Knud; Sporring, Jon; Hornbæk, Kasper

    2004-01-01

    Udgivelsesdato: March/April Rotation of three-dimensional objects by a two-dimensional mouse is a typical task in computer-aided design, operation simulations, and desktop virtual reality. The most commonly used rotation technique is a virtual trackball surrounding the object and operated by the mouse pointer. This article reviews and provides a mathematical foundation for virtual trackballs. The first, but still popular, virtual trackball was described by Chen et al. [CHECK END OF SENTENC...

  10. Server virtualization solutions

    OpenAIRE

    Jonasts, Gusts

    2012-01-01

    Currently in the information technology sector that is responsible for a server infrastructure is a huge development in the field of server virtualization on x86 computer architecture. As a prerequisite for such a virtualization development is growth in server productivity and underutilization of available computing power. Several companies in the market are working on two virtualization architectures – hypervizor and hosting. In this paper several of virtualization products that use host...

  11. Virtual currencies- Real opportunities?

    OpenAIRE

    Selldahl, Sara

    2013-01-01

    The European Central Bank defines virtual currencies as ”unregulated, digital money, which is issued and usually controlled by its developers, and used and accepted among the members of a specific virtual community.” (European Central Bank, 2012, p. 5) The interest in virtual currencies has increased immensely over the last few years as they become increasingly prevalent in our society across many different industries. Up until now, the field of virtual currencies has been mainly uncharted ...

  12. Virtual reality exposure therapy

    OpenAIRE

    Rothbaum, BO; Hodges, L; Kooper, R

    1997-01-01

    It has been proposed that virtual reality (VR) exposure may be an alternative to standard in vivo exposure. Virtual reality integrates real-time computer graphics, body tracking devices, visual displays, and other sensory input devices to immerse a participant in a computer- generated virtual environment. Virtual reality exposure is potentially an efficient and cost-effective treatment of anxiety disorders. VR exposure therapy reduced the fear of heights in the first control...

  13. Interactive Virtual Cinematography

    OpenAIRE

    Burelli, Paolo

    2012-01-01

    A virtual camera represents the point-of-view of the player through which sheperceives the game world and gets feedback on her actions. Thus, the virtualcamera plays a vital role in 3D computer games and aects player experienceand enjoyability in games. Interactive virtual cinematography is the process ofvisualising the content of a virtual environment by positioning and animatingthe virtual camera in the context of interactive applications such as a computergame.Camera placement and animatio...

  14. Comprehensive stroke centers may be associated with improved survival in hemorrhagic stroke.

    Science.gov (United States)

    McKinney, James S; Cheng, Jerry Q; Rybinnik, Igor; Kostis, John B

    2015-05-06

    Comprehensive stroke centers (CSCs) provide a full spectrum of neurological and neurosurgical services to treat complex stroke patients. CSCs have been shown to improve clinical outcomes and mitigate disparities in ischemic stroke patients. It is believed that CSCs also improve outcomes in hemorrhagic stroke. We used the Myocardial Infarction Data Acquisition System (MIDAS) database, which includes data on patients discharged with a primary diagnosis of intracerebral hemorrhage (ICH; International Classification of Diseases, Ninth Revision [ICD-9] 431) and subarachnoid hemorrhage (SAH; ICD-9 430) from all nonfederal acute care hospitals in New Jersey (NJ) between 1996 and 2012. Out-of-hospital deaths were assessed by matching MIDAS records with NJ death registration files. The primary outcome variable was 90-day all-cause mortality. The primary independent variable was CSC versus primary stroke center (PSC) and nonstroke center (NSC) admission. Multivariate logistic models were used to measure the effects of available covariates. Overall, 36 981 patients were admitted with a primary diagnosis of ICH or SAH during the study period, of which 40% were admitted to a CSC. Patients admitted to CSCs were more likely to have neurosurgical or endovascular interventions than those admitted to a PSC/NSC (18.9% vs. 4.7%; Pmortality (35.0% vs. 40.3%; odds ratio, 0.93; 95% confidence interval, 0.89 to 0.97) for hemorrhagic stroke. This was particularly true for those admitted with SAH. Hemorrhagic stroke patients admitted to CSCs are more likely to receive neurosurgical and endovascular treatments and be alive at 90 days than patients admitted to other hospitals. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  15. Diabetes, Heart Disease, and Stroke

    Science.gov (United States)

    ... Disease, & Other Dental Problems Diabetes, Sexual, & Bladder Problems Diabetes, Heart Disease, and Stroke Having diabetes means that ... help to stop. What is the link between diabetes, heart disease, and stroke? Over time, high blood ...

  16. Preventable Pediatric Stroke via Vaccination?

    Directory of Open Access Journals (Sweden)

    Craig A. Press

    2015-11-01

    Full Text Available Investigators from the Vascular Effects of Infection in Pediatric Stroke (VIPS group studied the risk of arterial ischemic stroke (AIS associated with minor infection and routine childhood vaccinations.

  17. Heart Disease and Stroke Statistics

    Science.gov (United States)

    ... Media for Heart.org Heart and Stroke Association Statistics Each year, the American Heart Association, in conjunction ... health and disease in the population. Heart & Stroke Statistics FAQs What is Prevalence? Prevalence is an estimate ...

  18. Virtual Reality: An Overview.

    Science.gov (United States)

    Franchi, Jorge

    1994-01-01

    Highlights of this overview of virtual reality include optics; interface devices; virtual worlds; potential applications, including medicine and archaeology; problems, including costs; current research and development; future possibilities; and a listing of vendors and suppliers of virtual reality products. (Contains 11 references.) (LRW)

  19. The Virtuality Continuum Revisited

    NARCIS (Netherlands)

    Nijholt, Antinus; Traum, D.; Zhai, Sh.; Kellogg, W.

    2005-01-01

    We survey the themes and the aims of a workshop devoted to the state-of-the-art virtuality continuum. In this continuum, ranging from fully virtual to real physical environments, allowing for mixed, augmented and desktop virtual reality, several perspectives can be taken. Originally, the emphasis

  20. Virtual Reference Services.

    Science.gov (United States)

    Brewer, Sally

    2003-01-01

    As the need to access information increases, school librarians must create virtual libraries. Linked to reliable reference resources, the virtual library extends the physical collection and library hours and lets students learn to use Web-based resources in a protected learning environment. The growing number of virtual schools increases the need…

  1. Prediction of Large Vessel Occlusions in Acute Stroke: National Institute of Health Stroke Scale Is Hard to Beat.

    Science.gov (United States)

    Vanacker, Peter; Heldner, Mirjam R; Amiguet, Michael; Faouzi, Mohamed; Cras, Patrick; Ntaios, George; Arnold, Marcel; Mattle, Heinrich P; Gralla, Jan; Fischer, Urs; Michel, Patrik

    2016-06-01

    Endovascular treatment for acute ischemic stroke with a large vessel occlusion was recently shown to be effective. We aimed to develop a score capable of predicting large vessel occlusion eligible for endovascular treatment in the early hospital management. Retrospective, cohort study. Two tertiary, Swiss stroke centers. Consecutive acute ischemic stroke patients (1,645 patients; Acute STroke Registry and Analysis of Lausanne registry), who had CT angiography within 6 and 12 hours of symptom onset, were categorized according to the occlusion site. Demographic and clinical information was used in logistic regression analysis to derive predictors of large vessel occlusion (defined as intracranial carotid, basilar, and M1 segment of middle cerebral artery occlusions). Based on logistic regression coefficients, an integer score was created and validated internally and externally (848 patients; Bernese Stroke Registry). None. Large vessel occlusions were present in 316 patients (21%) in the derivation and 566 (28%) in the external validation cohort. Five predictors added significantly to the score: National Institute of Health Stroke Scale at admission, hemineglect, female sex, atrial fibrillation, and no history of stroke and prestroke handicap (modified Rankin Scale score, < 2). Diagnostic accuracy in internal and external validation cohorts was excellent (area under the receiver operating characteristic curve, 0.84 both). The score performed slightly better than National Institute of Health Stroke Scale alone regarding prediction error (Wilcoxon signed rank test, p < 0.001) and regarding discriminatory power in derivation and pooled cohorts (area under the receiver operating characteristic curve, 0.81 vs 0.80; DeLong test, p = 0.02). Our score accurately predicts the presence of emergent large vessel occlusions, which are eligible for endovascular treatment. However, incorporation of additional demographic and historical information available on hospital arrival

  2. Agreement between routine electronic hospital discharge and Scottish Stroke Care Audit (SSCA) data in identifying stroke in the Scottish population.

    Science.gov (United States)

    Turner, Melanie; Barber, Mark; Dodds, Hazel; Dennis, Martin; Langhorne, Peter; Macleod, Mary-Joan

    2015-12-30

    In Scotland all non-obstetric, non-psychiatric acute inpatient and day case stays are recorded by an administrative hospital discharge database, the Scottish Morbidity Record (SMR01). The Scottish Stroke Care Audit (SSCA) collects data from all hospitals managing acute stroke in Scotland to support and improve quality of stroke care. The aim was to assess whether there were discrepancies between these data sources for admissions from 2010 to 2011. Records were matched when admission dates from the two data sources were within two days of each other and if an International Classification of Diseases (ICD) code of I61, I63, I64, or G45 was in the primary or secondary diagnosis field on SMR01. We also carried out a linkage analysis followed by a case-note review within one hospital in Scotland. There were a total of 22 416 entries on SSCA and 22 200 entries on SMR01. The concordance between SSCA and SMR01 was 16 823. SSCA contained 5593 strokes that were not present in SMR01, whereas SMR01 contained 185 strokes that were not present in SSCA. In the case-note review the concordance was 531, with SSCA containing 157 strokes that were not present in SMR01 and SMR01 containing 32 strokes that were not present in SSCA. When identifying strokes, hospital administrative discharge databases should be used with caution. Our results demonstrate that SSCA most accurately represents the number of strokes occurring in Scotland. This resource is useful for determining the provision of adequate patient care, stroke services and resources, and as a tool for research.

  3. Burden of Stroke in Qatar.

    Science.gov (United States)

    Ibrahim, Faisal; Deleu, Dirk; Akhtar, Naveed; Al-Yazeedi, Wafa; Mesraoua, Boulenouar; Kamran, Sadaat; Shuaib, Ashfaq

    2015-12-01

    Qatar is located on the northeastern coast of the Arabian Peninsula. The total population is over 2.1 million with around 15% being Qatari citizens. Hamad General Hospital (HGH) is the only tertiary referral governmental hospital in Qatar which admits acute (thrombolysis-eligible) stroke patients. To provide an overview of the burden of stroke in Qatar. Data from literature databases, online sources and our stroke registry were collated to identify information on the burden of stroke in Qatar. Overall, over 80% of all stroke patients in Qatar are admitted in HGH. In 2010, the age-standardized incidence for first-ever ischemic stroke was 51.88/100,000 person-years. To date our stroke registry reveals that 79% of all stroke patients are male and almost 50% of stroke patients are 50 years or less. Hypertension, diabetes and dyslipidemia are the main predisposing factors for stroke, with ischemic stroke being more common (87%) than hemorrhagic stroke (13%). Despite the lack of a stroke unit, 9% of ischemic stroke patients are being thrombolyzed. However the presence of a stroke ward allows swift turnover of patients with a length of stay of less than 5 days before discharge or, if required, transfer to the fully-equipped hospital-based rehabilitation service. Several community awareness programs are ongoing, in addition to several research programs funded by the Qatar National Research Fund and Hamad Medical Corporation. In a country where over 15% of the population suffers from diabetes there is continuous need for national community-based awareness campaigns, prevention and educational programs particularly targeting patients and health care workers. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  4. SAR: Stroke Authorship Recognition

    KAUST Repository

    Shaheen, Sara; Rockwood, Alyn; Ghanem, Bernard

    2015-01-01

    Are simple strokes unique to the artist or designer who renders them? If so, can this idea be used to identify authorship or to classify artistic drawings? Also, could training methods be devised to develop particular styles? To answer these questions, we propose the Stroke Authorship Recognition (SAR) approach, a novel method that distinguishes the authorship of 2D digitized drawings. SAR converts a drawing into a histogram of stroke attributes that is discriminative of authorship. We provide extensive classification experiments on a large variety of data sets, which validate SAR's ability to distinguish unique authorship of artists and designers. We also demonstrate the usefulness of SAR in several applications including the detection of fraudulent sketches, the training and monitoring of artists in learning a particular new style and the first quantitative way to measure the quality of automatic sketch synthesis tools. © 2015 The Eurographics Association and John Wiley & Sons Ltd.

  5. Rehabilitation after stroke.

    Science.gov (United States)

    Knecht, Stefan; Hesse, Stefan; Oster, Peter

    2011-09-01

    Stroke is becoming more common in Germany as the population ages. Its long-term sequelae can be alleviated by early reperfusion in stroke units and by complication management and functional restoration in early-rehabilitation and rehabilitation centers. Selective review of the literature. Successful rehabilitation depends on systematic treatment by an interdisciplinary team of experienced specialists. In the area of functional restoration, there has been major progress in our understanding of the physiology of learning, relearning, training, and neuroenhancement. There have also been advances in supportive pharmacotherapy and robot technology. Well-organized acute and intermediate rehabilitation after stroke can provide patients with the best functional results attainable on the basis of our current scientific understanding. Further experimental and clinical studies will be needed to expand our knowledge and improve the efficacy of rehabilitation.

  6. Mortality after hemorrhagic stroke

    DEFF Research Database (Denmark)

    González-Pérez, Antonio; Gaist, David; Wallander, Mari-Ann

    2013-01-01

    OBJECTIVE: To investigate short-term case fatality and long-term mortality after intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) using data from The Health Improvement Network database. METHODS: Thirty-day case fatality was stratified by age, sex, and calendar year after ICH...... = 0.03). CONCLUSIONS: More than one-third of individuals die in the first month after hemorrhagic stroke, and patients younger than 50 years are more likely to die after ICH than SAH. Short-term case fatality has decreased over time. Patients who survive hemorrhagic stroke have a continuing elevated......, 54.6% for 80-89 years; SAH: 20.3% for 20-49 years, 56.7% for 80-89 years; both p-trend stroke patients...

  7. SAR: Stroke Authorship Recognition

    KAUST Repository

    Shaheen, Sara

    2015-10-15

    Are simple strokes unique to the artist or designer who renders them? If so, can this idea be used to identify authorship or to classify artistic drawings? Also, could training methods be devised to develop particular styles? To answer these questions, we propose the Stroke Authorship Recognition (SAR) approach, a novel method that distinguishes the authorship of 2D digitized drawings. SAR converts a drawing into a histogram of stroke attributes that is discriminative of authorship. We provide extensive classification experiments on a large variety of data sets, which validate SAR\\'s ability to distinguish unique authorship of artists and designers. We also demonstrate the usefulness of SAR in several applications including the detection of fraudulent sketches, the training and monitoring of artists in learning a particular new style and the first quantitative way to measure the quality of automatic sketch synthesis tools. © 2015 The Eurographics Association and John Wiley & Sons Ltd.

  8. Risk factors, mortality, and timing of ischemic and hemorrhagic stroke with left ventricular assist devices.

    Science.gov (United States)

    Frontera, Jennifer A; Starling, Randall; Cho, Sung-Min; Nowacki, Amy S; Uchino, Ken; Hussain, M Shazam; Mountis, Maria; Moazami, Nader

    2017-06-01

    Stroke is a major cause of mortality after left ventricular assist device (LVAD) placement. Prospectively collected data of patients with HeartMate II (n = 332) and HeartWare (n = 70) LVADs from October 21, 2004, to May 19, 2015, were reviewed. Predictors of early (during index hospitalization) and late (post-discharge) ischemic and hemorrhagic stroke and association of stroke subtypes with mortality were assessed. Of 402 patients, 83 strokes occurred in 69 patients (17%; 0.14 events per patient-year [EPPY]): early ischemic stroke in 18/402 (4%; 0.03 EPPY), early hemorrhagic stroke in 11/402 (3%; 0.02 EPPY), late ischemic stroke in 25/402 (6%; 0.04 EPPY) and late hemorrhagic stroke in 29/402 (7%; 0.05 EPPY). Risk of stroke and death among patients with stroke was bimodal with highest risks immediately post-implant and increasing again 9-12 months later. Risk of death declined over time in patients without stroke. Modifiable stroke risk factors varied according to timing and stroke type, including tobacco use, bacteremia, pump thrombosis, pump infection, and hypertension (all p hemorrhagic stroke (adjusted odds ratio [aOR] 4.3, 95% confidence interval [CI] 1.0-17.8, p = 0.04), late ischemic stroke (aOR 3.2, 95% CI 1.1-9.0, p = 0.03), and late hemorrhagic stroke (aOR 3.7, 95% CI 1.5-9.2, p = 0.005) predicted death, whereas early ischemic stroke did not. Stroke is a leading cause and predictor of death in patients with LVADs. Risk of stroke and death among patients with stroke is bimodal, with highest risk at time of implant and increasing risk again after 9-12 months. Management of modifiable risk factors may reduce stroke and mortality rates. Copyright © 2017 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  9. Developing a Virtual Rock Deformation Laboratory

    Science.gov (United States)

    Zhu, W.; Ougier-simonin, A.; Lisabeth, H. P.; Banker, J. S.

    2012-12-01

    Experimental rock physics plays an important role in advancing earthquake research. Despite its importance in geophysics, reservoir engineering, waste deposits and energy resources, most geology departments in U.S. universities don't have rock deformation facilities. A virtual deformation laboratory can serve as an efficient tool to help geology students naturally and internationally learn about rock deformation. Working with computer science engineers, we built a virtual deformation laboratory that aims at fostering user interaction to facilitate classroom and outreach teaching and learning. The virtual lab is built to center around a triaxial deformation apparatus in which laboratory measurements of mechanical and transport properties such as stress, axial and radial strains, acoustic emission activities, wave velocities, and permeability are demonstrated. A student user can create her avatar to enter the virtual lab. In the virtual lab, the avatar can browse and choose among various rock samples, determine the testing conditions (pressure, temperature, strain rate, loading paths), then operate the virtual deformation machine to observe how deformation changes physical properties of rocks. Actual experimental results on the mechanical, frictional, sonic, acoustic and transport properties of different rocks at different conditions are compiled. The data acquisition system in the virtual lab is linked to the complied experimental data. Structural and microstructural images of deformed rocks are up-loaded and linked to different deformation tests. The integration of the microstructural image and the deformation data allows the student to visualize how forces reshape the structure of the rock and change the physical properties. The virtual lab is built using the Game Engine. The geological background, outstanding questions related to the geological environment, and physical and mechanical concepts associated with the problem will be illustrated on the web portal. In

  10. osni.info-Using free/libre/open source software to build a virtual international community for open source nursing informatics.

    Science.gov (United States)

    Oyri, Karl; Murray, Peter J

    2005-12-01

    Many health informatics organizations seem to be slow to take up the advantages of dynamic, web-based technologies for providing services to, and interaction with, their members; these are often the very technologies they promote for use within healthcare environments. This paper aims to introduce some of the many free/libre/open source (FLOSS) applications that are now available to develop interactive websites and dynamic online communities as part of the structure of health informatics organizations, and to show how the Open Source Nursing Informatics Working Group (OSNI) of the special interest group in nursing informatics of the International Medical Informatics Association (IMIA-NI) is using some of these tools to develop an online community of nurse informaticians through their website, at . Some background introduction to FLOSS applications is used for the benefit of those less familiar with such tools, and examples of some of the FLOSS content management systems (CMS) being used by OSNI are described. The experiences of the OSNI will facilitate a knowledgeable nursing contribution to the wider discussions on the applications of FLOSS within health and healthcare, and provides a model that many other groups could adopt.

  11. Questions and Answers about Stroke

    Science.gov (United States)

    ... stroke. High blood pressure increases your risk of stroke four to six times. Heart disease, especially a condition ... leading cause of serious, long-term adult disability. Four million Americans are living with the effects of stroke. The length of time to recover from a ...

  12. Stroke and Episodic Memory Disorders

    Science.gov (United States)

    Lim, Chun; Alexander, Michael P.

    2009-01-01

    Memory impairments are common after stroke, and the anatomical basis for impairments may be quite variable. To determine the range of stroke-related memory impairment, we identified all case reports and group studies through the Medline database and the Science Citation Index. There is no hypothesis about memory that is unique to stroke, but there…

  13. Foundational Issues in Touch-Screen Stroke Gesture Design - An Integrative Review

    OpenAIRE

    Zhai , Shumin; Kristensson , Per Ola; Appert , Caroline; Andersen , Tue Haste; Cao , Xiang

    2012-01-01

    International audience; The potential for using stroke gestures to enter, retrieve and select commands and text has been recently unleashed by the popularity of touchscreen devices. This monograph provides a state-of-the-art inte- grative review of a body of human-computer interaction research on stroke gestures. It begins with an analysis of the design dimensions of stroke gestures as an interaction medium. The analysis classifies gestures into analogue versus abstract gestures, gestures for...

  14. Impact of Generator Stroke Length on Energy Production for a Direct Drive Wave Energy Converter

    Directory of Open Access Journals (Sweden)

    Yue Hong

    2016-09-01

    Full Text Available The Lysekil wave energy converter (WEC, developed by the wave energy research group of Uppsala University, has evolved through a variety of mechanical designs since the first prototype was installed in 2006. The hundreds of engineering decisions made throughout the design processes have been based on a combination of theory, know-how from previous experiments, and educated guesses. One key parameter in the design of the WECs linear generator is the stroke length. A long stroke requires a taller WEC with associated economical and mechanical challenges, but a short stroke limits the power production. The 2-m stroke of the current WECs has been an educated guess for the Swedish wave climate, though the consequences of this choice on energy absorption have not been studied. When the WEC technology is considered for international waters, with larger waves and challenges of energy absorption and survivability, the subject of stroke length becomes even more relevant. This paper studies the impact of generator stroke length on energy absorption for three sites off the coasts of Sweden, Chile and Scotland. 2-m, 4-m, and unlimited stroke are considered. Power matrices for the studied WEC prototype are presented for each of the studied stroke lengths. Presented results quantify the losses incurred by a limited stroke. The results indicate that a 2-m stroke length is likely to be a good choice for Sweden, but 4-m is likely to be necessary in more energetic international waters.

  15. Mridangam stroke dataset

    OpenAIRE

    CompMusic

    2014-01-01

    The audio examples were recorded from a professional Carnatic percussionist in a semi-anechoic studio conditions by Akshay Anantapadmanabhan using SM-58 microphones and an H4n ZOOM recorder. The audio was sampled at 44.1 kHz and stored as 16 bit wav files. The dataset can be used for training models for each Mridangam stroke. /n/nA detailed description of the Mridangam and its strokes can be found in the paper below. A part of the dataset was used in the following paper. /nAkshay Anantapadman...

  16. Stroke and Therapeutic Hypothermia

    Directory of Open Access Journals (Sweden)

    Ozlem Ozkan Kuscu

    2016-09-01

    Full Text Available Stroke is significant cause of morbidity and mortality caused by disruption of blood flow. Neural injury occurs with two stage; while primary neural injury occurs with disruption of blood flow, after days and hours with metabolic processes secondary injury develops in tissues which is non injured in the first stage. Therefore it is important to prevent and treat the secondary injury as much as preventing and treating the primary neural injury. In this article developing pathophysiological changes after stroke, mechanisms of therapeutic hypothermia, application methods, the factors that determine the effectiveness, side effects and complications were reviewed. [Archives Medical Review Journal 2016; 25(3.000: 351-368

  17. Biotherapies in stroke.

    Science.gov (United States)

    Detante, O; Jaillard, A; Moisan, A; Barbieux, M; Favre, I M; Garambois, K; Hommel, M; Remy, C

    2014-12-01

    Stroke is the second leading cause of death worldwide and the most common cause of severe disability. Neuroprotection and repair mechanisms supporting endogenous brain plasticity are often insufficient to allow complete recovery. While numerous neuroprotective drugs trials have failed to demonstrate benefits for patients, they have provided interesting translational research lessons related to neurorestorative therapy mechanisms in stroke. Stroke damage is not limited to neurons but involve all brain cell type including the extracellular matrix in a "glio-neurovascular niche". Targeting a range of host brain cells, biotherapies such as growth factors and therapeutic cells, currently hold great promise as a regenerative medical strategy for stroke. These techniques can promote both neuroprotection and delayed neural repair through neuro-synaptogenesis, angiogenesis, oligodendrogliogenesis, axonal sprouting and immunomodulatory effects. Their complex mechanisms of action are interdependent and vary according to the particular growth factor or grafted cell type. For example, while "peripheral" stem or stromal cells can provide paracrine trophic support, neural stem/progenitor cells (NSC) or mature neurons can act as more direct neural replacements. With a wide therapeutic time window after stroke, biotherapies could be used to treat many patients. However, guidelines for selecting the optimal time window, and the best delivery routes and doses are still debated and the answers may depend on the chosen product and its expected mechanism including early neuroprotection, delayed neural repair, trophic systemic transient effects or graft survival and integration. Currently, the great variety of growth factors, cell sources and cell therapy products form a therapeutic arsenal that is available for stroke treatment. Their effective clinical use will require prior careful considerations regarding safety (e.g. tumorgenicity, immunogenicity), potential efficacy, cell

  18. Estimating the cost-effectiveness of stroke units in France compared with conventional care.

    Science.gov (United States)

    Launois, R; Giroud, M; Mégnigbêto, A C; Le Lay, K; Présenté, G; Mahagne, M H; Durand, I; Gaudin, A F

    2004-03-01

    The incidence of stroke in France is estimated at between 120 000 and 150 000 cases per year. This modeling study assessed the clinical and economic benefits of establishing specialized stroke units compared with conventional care. Data from the Dijon stroke registry were used to determine healthcare trajectories according to the degree of autonomy and organization of patient care. The relative risks of death or institutionalization or death or dependence after passage through a stroke unit were compared with conventional care. These risks were then inserted with the costing data into a Markov model to estimate the cost-effectiveness of stroke units. Patients cared for in a stroke unit survive more trimesters without sequelae in the 5 years after hospitalization than those cared for conventionally (11.6 versus 8.28 trimesters). The mean cost per patient at 5 years was estimated at 30 983 for conventional care and 34 638 in a stroke unit. An incremental cost-effectiveness ratio for stroke units of 1359 per year of life gained without disability was estimated. The cost-effectiveness ratio for stroke units is much lower than the threshold (53 400 ) of acceptability recognized by the international scientific community. This finding justifies organizational changes in the management of stroke patients and the establishment of stroke units in France.

  19. Causes of Death Data in the Global Burden of Disease Estimates for Ischemic and Hemorrhagic Stroke.

    Science.gov (United States)

    Truelsen, Thomas; Krarup, Lars-Henrik; Iversen, Helle K; Mensah, George A; Feigin, Valery L; Sposato, Luciano A; Naghavi, Mohsen

    2015-01-01

    Stroke mortality estimates in the Global Burden of Disease (GBD) study are based on routine mortality statistics and redistribution of ill-defined codes that cannot be a cause of death, the so-called 'garbage codes' (GCs). This study describes the contribution of these codes to stroke mortality estimates. All available mortality data were compiled and non-specific cause codes were redistributed based on literature review and statistical methods. Ill-defined codes were redistributed to their specific cause of disease by age, sex, country and year. The reassignment was done based on the International Classification of Diseases and the pathology behind each code by checking multiple causes of death and literature review. Unspecified stroke and primary and secondary hypertension are leading contributing 'GCs' to stroke mortality estimates for hemorrhagic stroke (HS) and ischemic stroke (IS). There were marked differences in the fraction of death assigned to IS and HS for unspecified stroke and hypertension between GBD regions and between age groups. A large proportion of stroke fatalities are derived from the redistribution of 'unspecified stroke' and 'hypertension' with marked regional differences. Future advancements in stroke certification, data collections and statistical analyses may improve the estimation of the global stroke burden. © 2015 S. Karger AG, Basel.

  20. Virtualization A Manager's Guide

    CERN Document Server

    Kusnetzky, Dan

    2011-01-01

    What exactly is virtualization? As this concise book explains, virtualization is a smorgasbord of technologies that offer organizations many advantages, whether you're managing extremely large stores of rapidly changing data, scaling out an application, or harnessing huge amounts of computational power. With this guide, you get an overview of the five main types of virtualization technology, along with information on security, management, and modern use cases. Topics include: Access virtualization-Allows access to any application from any deviceApplication virtualization-Enables applications