Research Initiative Aims to Improve Post-Stroke Rehabilitation

In the United States, 700,000 people suffer a stroke each year,
according to the National Institute of Neurological Disorders and
Stroke. For patients lucky enough to survive, post-stroke
rehabilitation will be required for the rest of their lives. Health care
professionals promote range-of-motion exercises in order to strengthen muscles
that may have been left weakened or partially paralyzed from a stroke. The
provider’s ability to properly and effectively communicate
biomechanical data to the patient is crucial to their
independence and improved quality of life.

Visual feedback

Philip Rowe, PhD, lead researcher for the Department of Bioengineering
at Strathclyde University in Glasgow, UK, told O&P Business
that biomechanical data has been difficult to communicate in
clinical practice. As a result, a research project led by Rowe conducted at
Strathclyde University with Alastair Macdonald, PhD, professor at the Glasgow
School of Art and Lynne Baillie, PhD, director of Multimodal Interaction
Research Group at Glasgow Caledonian University, will use existing technology
that visualizes and reanimates measurements to improve rehabilitation after
stroke, speed up recovery from joint replacements and prevent older individuals
from falling. The project will enlist the knowledge of engineers, scientists
and health care professionals from across the United Kingdom.

The data presented to the patient visually — rather than in tables
and charts — will enhance his or her educational understanding of their
biomechanical problems and further the discussion for solutions, according to
Rowe. Instead of waiting for a health care professional’s interpretation
of test results, patients can recognize their results instantaneously.

Researchers use infrared cameras to record patient movement.
Researchers use infrared cameras
to record patient movement.
Images: Philip Rowe

“If you give a patient feedback in a mirror, it’s backwards,
so obviously that is not helpful,” Rowe said. “But if we can give
them a virtual reality-type of image which is based on the true movement of
their arm, the patient can concentrate on the movement of their arm and its

The goal for Rowe and his research collaborators is to involve the
patient in the process as much as possible. The more involved patients feel,
the more likely they are to manage and adhere to their conditions and exercise

“Through visualization can actually come forms of therapy that we
have not yet explored,” Rowe explained. “Visual feedback could bring
about new ways for the neurological system to relearn better.”

The post-stroke patient will be asked to perform numerous task-oriented
exercises repetitiously during rehabilitation. One of the challenges Rowe and
his team faces is designing a program that is both interesting for the patient
and efficient for the health care practitioner.

“It will massively change the experience for the patient as well as
the allied health professional,” Baillie said. “By using games and
other visualizations, we hope to transform rehabilitation from a chore to
something enjoyable and engaging.”

The technology

In order to create the animations, researchers capture the
patient’s biomechanical data in Strathclyde University’s specialist
gait laboratory. Infrared cameras measure and read the patient’s
movements. The movement’s impact on the patient’s body is measured
using force-plate sensors built into the lab’s floor. A biomechanical
analysis of the patient in motion can then be captured.

It will be possible to analyze data including timing and foot-fall
symmetry, joint displacement angles and muscle and ligament forces. Rowe and
his research team will overlay aspects of the biomechanical data on top of the
animation. This enables the patient to see him or herself moving and at the
same time visualize the joints or muscles that are flaring at any given time.
The animations could expose acceptable or unacceptable levels of stress on the

“With this system, patients will be able to view historical data of
how their movements improved over time,” Baillie explained.

Using forceplates, researchers can measure the impact movements have on the body and analyze foot-fall symmetry.
Using forceplates, researchers
can measure the impact movements have on the body and analyze foot-fall
Images: Philip Rowe

Rowe and his team plan to develop portable motion capture systems
enabling visualization for patients rehabilitating from home or in community
health centers.

The biomechanical community has used this technology in the past as a
way for scientists to verify data. In fact, Rowe emphasized that he was not
developing new measurement technology — just implementing existing
technology in a new way.

“What we’re really doing is taking that technology —
visualization and ability — and turning it to clinical usage as opposed to
scientific usage,” Rowe said.


The project is funded by the Lifelong Health and Wellbeing Program and
is being developed by Strathclyde University in partnership with the Glasgow
School of Art, Glasgow Caledonian University, Glasgow University, Newcastle
University, Southampton University and the National Health Services in West of

Rowe will perform five randomized, controlled pilot trials involving
different scenarios with different levels of complexity, throughout the next 3
years. He hopes the project will serve a therapeutic, diagnostic and
preventable purpose, especially for the growing number of older individuals
around the world.

“This could be diagnostic as well as therapeutic,” Rowe said.
“For example, we have a project where we are fitting post-stroke patients
with AFOs. We hope the feedback will help them fit the AFO correctly. The
feedback will tell them if they are producing any abnormal movements of the
joint, which is another way of fitting the device.”

The range of projects includes providing the biomechanical benefits of
balance and bone strength to elderly patients who are prone to falling. Rowe
has pilot projects for knee replacement patients who must perform their
rehabilitation at home as well as for stroke patients with upper and lower limb
deficiencies. Rowe and Baillie will be posting videos on the upcoming trials
and frequent updates on their website.

“Overall, we are observing how well visualization in a therapeutic
context works,” Rowe said. “I think both communication improvements
as well as therapeutic methods will help improve patient outcomes.” —
by Anthony Calabro

For more information:


Frequently, words are not enough to demonstrate to a
patient what they are doing wrong biomechanically or what we would like them to
do differently. Often, I find myself involved in a sort of pantomime to get my
point across.

Biofeedback with digital displays has been used by
physical therapists to improve outcomes, but not with biomechanical animation
as described in this article. Combat troops use virtual war zones to practice
assault techniques. Airline pilots use flight simulators to improve
performance. I expect that Rowe and his team will find that many patients will
also benefit from visual learning by using animated data.

Additionally, Rowe suspects that new “forms of
therapy” may be discovered “through visualization.” This should
be of particular interest to the O&P community when we consider that
diagnoses involving a neurological component, such as amputation or
cerebrovascular accident may respond in a positive way to visualization with

If Rowe’s work demonstrates improved outcomes, then
the question becomes whether or not there is enough benefit to justify the cost
of utilizing this technology in rehabilitation applications. It makes me wonder
when the O&P profession will have a reimbursement system that recognizes
the service component of the care we provide, including the use of technologies
such as this and not just the device we fit.

—Scott Cummings, CPO, PT, FAAOP
Next Step
O&P and president-elect, The American Academy of Orthotists and

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