SBIR-STTR Award

It is hypothesized that for elderly post-stroke patients improving upper extremity coordination, as well as strengthening its muscles may be accomplished simultaneously with cognitive training, and done in an entertaining way. This objective implements "a healthy mind in a healthy body" single-point-of-care approach. The long-term objective of this project is to develop an improved combined therapy approach that is superior to the way physical therapy and cognitive training are done separately today on the same patient population. The purpose of this investigation is to develop and feasibility test the prototype BC 100 system integrated with custom game-like virtual reality simulations, gravity-gradated assistance/resistance and grasp exertion. This system should accommodate both high-functioning and low-functioning patients post-stroke, being superior to off-the-shelf gaming systems and safer than rehabilitation robots. SPECIFIC AIMS The first aim is to develop the BC 100 system for improving arm/shoulder motion, motor control, endurance, grasp strength, memory, anticipation and reaction time in elderly patients post-stroke (subacute or chronic). The second aim is to evaluate the functionality of the prototype for elderly adults more than 1 moth post-stroke by piloting a 4-week intensive and simultaneous physical therapy and cognitive training of the affected upper extremity. METHODS 1) Construct the BC 100 system by creating a low-friction, vision-tracked rehabilitation table that tilts automatically to allow assistance/resistance to either arm motion; 2) develop virtual rehabilitation software for elderly patients post-stroke with games training simultaneously the physical and the cognitive aspects their disability, while they are confined to log-term care; 3) Develop a secure web-accessible database for reporting and remote data analysis. Data from the BC 100 will be sampled transparently in real time during play and uploaded to Bright Cloud International bladed servers. 4) pilot study with 4 elderly subjects without disability to uncover technology problems; 5) Feasibility clinical study with 6 elderly subjects with hemiplegia following stroke participating in a 4-week training program of their affected upper extremity and cognition on the BC 100 systems. Subjects will be evaluated for physical and cognitive function using standardized tests at the start and end of training. Computerized non-standardized measures (arm reach, arm velocity, game scores, etc) will be compared to determine if there is a correlation with the standardized tests. NIH RELEVANCE This project will develop a new device and therapeutic method for training upper extremity and cognition in an integrated way providing a single-point-of-care solution. The same approach can be extended to other patient populations, and age groups.

Public Health Relevance:
A product that simultaneously augments the physical strength, cognition and well being of elderly patients confined to long-term care improves their quality of life/participation, and reduces health care costs by allowing them to work on rehabilitation games in their free time without the intervention of a therapist. By integrating rehabilitation for shoulder/arm/grasp control and strength with cognitive (memory, reasoning) training the product improves access to health care by facilitating a single-point team-care therapy. The ability of the product to also be used in the future in acute rehabilitation further reduces health care costs by accelerating return to productive life.

Thesaurus Terms:
21+ Years Old; Access To Care; Access To Health Care; Access To Healthcare; Accessibility Of Health Care; Activities Of Daily Living; Activities Of Everyday Life; Acute; Adult; Affect; Age Group Unspecified; Age-Years; Aged 65 And Over; Analysis, Data; Apoplexy; Arm; Articular Range Of Motion; Asses; Availability Of Health Services; Behavior Therapy, Cognitive; Behavioral Therapy; Body Of Uterus; Care, Health; Caring; Cerebral Stroke; Cerebrovascular Apoplexy; Cerebrovascular Stroke; Cerebrovascular Accident; Certification; Chronic; Clinical; Clinical Evaluation; Clinical Research; Clinical Study; Clinical Testing; Cognition; Cognitive; Cognitive Therapy; Computer Programs; Computer Software; Consult; Corpus; Corpus Uteri; Counseling; Custom; Data; Data Analyses; Data Banks; Data Bases; Data Collection; Databank, Electronic; Databanks; Database, Electronic; Databases; Depression; Development; Devices; Donkey; Education; Educational Aspects; Elderly; Elderly, Over 65; Elements; Equus Asinus; Evaluation; Exertion; Feasibility Studies; Force Of Gravity; Friction; Future; Goals; Graph; Gravities; Grips; Hand; Health Care Costs; Health Costs; Health Services Accessibility; Healthcare; Healthcare Costs; Hemiplegia; Hour; Human Pathology; Human, Adult; Improve Access; International; Intervention; Intervention Strategies; Investigation; Jobs; Joint Range Of Motion; Knowledge; Lead; Legal; Legal Patent; Life; Literature; Load-Bearing; Loadbearing; Long-Term Care; Measures; Medical; Membrum Superius; Memory; Memory, Immediate; Memory, Short-Term; Memory, Shortterm; Mental Depression; Mental Health; Mental Hygiene; Methods; Mind; Modification; Monitor; Moths; Motion; Motor; Muscle; Muscle Tissue; Nih; National Institutes Of Health; National Institutes Of Health (U.S.); Occupations; Patents; Patient Education; Patient Instruction; Patient Training; Patients; Pb Element; Physiatric Procedure; Physical Health Services / Rehabilitation; Physical Medicine Procedure; Physical Therapeutics; Physical Therapy Procedure; Physical Therapy Techniques; Physical Therapy; Physiotherapy; Physiotherapy (Techniques); Physiotherapy Procedure; Pilot Projects; Play; Professional Postions; Psyche Structure; Psychological Health; Psychologist; Psychotherapy, Cognitive; Qol; Quality Of Life; Questionnaires; Range Of Motion, Articular; Reaction Time; Recruitment Activity; Rehabilitation; Rehabilitation Therapy; Rehabilitation, Medical; Reporting; Resistance; Response Rt; Response Time; Rights; Robot; Running; Sbir; Sbirs (R43/44); Sampling; Savings; Secure; Short-Term Memory; Shoulder; Sight; Small Business Innovation Research; Small Business Innovation Research Grant; Software; Solutions; Stroke; System; System, Loinc Axis 4; Technology; Testing; Therapeutic; Therapy, Cognition; Time; Training; Training Programs; United States National Institutes Of Health; Universities; Upper Extremity; Upper Limb; Upper Arm; Uterine Body; Vascular Accident, Brain; Video Games; Vision; Wechsler Scales; Weight-Bearing; Weight-Bearing State; Weightbearing; Work; Access To Services; Access To Treatment; Adult Human (21+); Advanced Age; Age Group; Availability Of Services; Base; Brain Attack; Cerebral Vascular Accident; Clinical Data Repository; Clinical Data Warehouse; Clinical Test; Cognitive Behavior Intervention; Cognitive Behavior Modification; Cognitive Behavioral Intervention; Cognitive Behavioral Modification; Cognitive Behavioral Therapy; Cognitive Function; Cognitive Training; Computer Program/Software; Computerized; Daily Living Functionality; Data Repository; Design; Designing; Disability; Elderly Patient; Elders; Experience; Extended Care; Flexibility; Functional Ability; Functional Capacity; Geriatric; Grasp; Health Care Availability; Health Care Service Access; Health Care Service Availability; Health Services Availability; Healthcare Access Availability; Healthcare Service Access; Healthcare Service Availability; Heavy Metal Pb; Heavy Metal Lead; Improved; Interventional Strategy; Late Life; Later Life; Mental; Motor Control; Older Adult; Older Patient; Older Person; Patient Population; Pilot Study; Point Of Care; Post Stroke; Poststroke; Prototype; Psychologic; Psychological; Psychomotor Reaction Time; Public Health Relevance; Range Of Motion; Recruit; Rehabilitative; Relational Database; Research Clinical Testing; Resistant; Senior Citizen; Simulation; Standardize Measure; Stem; Stroke; Time Use; Virtual; Virtual Reality; Volunteer; Web-Accessible; Working Memory

It is hypothesized that the use robotic rehabilitation tables coupled with virtual reality games with elderly stroke survivors residents in skilled nursin facilities (SNFs) will: 1) improve and maintain upper extremity uni-manual and bimanual function, reach, strength and ADL independence; 2) improve and maintain cognition (memory, focus, problem solving); and 3) provide emotive uplifting and maintain it. This implements an integrative, single-point-of-care safe rehabilitation approach. The objectives of the project are 1 to develop a novel uni-manual and bimanual training device that is cheaper and safer than rehabilitation robots; 2) a virtual reality-based adaptable and integrative maintenance program that is clinically effective and engaging for elderly stroke survivors and other patient population. SPECIFIC AIMS 1) to develop the BrightArm Duo system for improving arm/shoulder motion range, shoulder strength, endurance, grasp strength, bimanual function and ADL independence, short-term memory, focusing, executive function and reduce depression in SNF residents chronic post-stroke; 2) to evaluate the new system for rehabilitation and maintenance therapy through a multi-site, longitudinal, randomized controlled study of stroke survivors over a 12 month period. METHODS 1) Construct the BrightArm Duo system by designing and building a new tracking work surface and computerized forearm supports; 2) Develop custom rehabilitation games that incorporate uni- and bimanual motor and cognitive training elements and automatically adapt to each patient. The games should combine to induce >350 repetitions/session; 3) Develop a secure web-accessible database module for game data storage and analysis and ability to play against residents in other SNFs. Data will be sampled transparently in real time during play and uploaded to BCI clinical server; 4) Usability study with healthy elderly adults, to uncover technical problems; 5) Longitudinal, multi-site randomized controlled study with elderly stroke survivors that are residents at two SNFs in New Jersey. Subjects will be randomized into a control group (N=16) and an experimental group (N=32). The control group will continue with existing health maintenance programs. The experimental group will have existing maintenance program plus an additional 8 week initial intensive training, followed by periodic "booster" rehabilitation sessions. All subjects will have multiple evaluations by blinded clinicians for physical and cognitive/emotive function. Existing maintenance programs at the two facilities will be documented in administration to all study participants. The experimental group will rate the BrightArm Duo therapy usefulness and gained independence in ADLs. NIH RELEVANCE A new device and therapeutic/maintenance method for uni/bimanual arm rehabilitation and cognition/emotive therapy in a single-point-of-care. The approach can be extended to other patient populations with motor and cognitive co-morbidities acute, sub-acute and chronic, adult and paediatric.

Public Health Relevance:


Public Health Relevance:
Costs associated with stroke are close to 50 billion a year in the United States. A product the simultaneously improves and maintains arm uni-manual and bimanual function, increases arm strength, improves ability to focus and memory, and lifts morale benefits elderly stroke survivors and other patient populations (traumatic brain injury, post-traumatic stress disorder, chronic pain, Alzheimer's Disease, pediatric). The product facilitates a single-point-of-care therapy that reduces health care costs.

Public Health Relevance Statement:


Public Health Relevance:
Costs associated with stroke are close to 50 billion a year in the United States. A product the simultaneously improves and maintains arm uni-manual and bimanual function, increases arm strength, improves ability to focus and memory, and lifts morale benefits elderly stroke survivors and other patient populations (traumatic brain injury, post-traumatic stress disorder, chronic pain, Alzheimer's Disease, pediatric). The product facilitates a single-point-of-care therapy that reduces health care costs.

Project Terms:
Accounting; Acute; acute stroke; Adult; Age; age group; age related; Alzheimer's Disease; arm; Arthritis; Articular Range of Motion; Auditory; base; Blinded; Caring; Childhood; Chronic; chronic pain; Clinical; Clinical Research; Cognition; Cognitive; Cognitive deficits; cognitive training; Communication; Comorbidity; Computer software; computerized; Control Groups; cost; Coupled; Custom; Data; Data Analyses; Data Collection; Data Storage and Retrieval; Databases; Delayed Memory; Depressed mood; design; Devices; digital; Elderly; Elements; Evaluation; executive function; experience; Force of Gravity; Forearm; Friction; Friends; functional gain; Funding; Goals; grasp; Health; Health Care Costs; Health care facility; healthy volunteer; Height; improved; International; Intervention; Libraries; Lifting; Location; Maintenance; Maintenance Therapy; Manuals; Medical; Memory; Mental Depression; Methods; Monitor; Morale; Motivation; Motor; motor deficit; Neurosciences; New Jersey; novel; Occupational Therapy; Outcome; Participant; patient population; Patients; Performance; Phase; phase 2 study; Play; point of care; Population; post stroke; Post-Traumatic Stress Disorders; Problem Solving; programs; psychologic; public health relevance; Quality of life; Randomized; Randomized Controlled Trials; Rehabilitation therapy; Relative (related person); Reporting; Rewards; Robot; Robotics; Running; Sampling; Secure; self esteem; Short-Term Memory; Shoulder; Site; Skilled Nursing Facilities; Small Business Innovation Research Grant; stroke; success; Surface; Survivors; System; Technology; Testing; Therapeutic; therapy duration; Time; Training; Traumatic Brain Injury; United States; United States National Institutes of Health; Upper Extremity; usability; Variant; virtual; virtual reality; web-accessible; Wireless Technology; Work