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#Stroke "Stroke"

Stroke

 

Each year, around 15 million people suffer a new cardiovascular insult, with a mortality rate around 30 percent. Another third of these people suffer permanent physical disorders, which cannot be fully rehabilitated by standard therapy.

 

A prolonged period of mobility reduction not only affects the patient’s quality of life, but can also entail more serious complications such as pneumonia, thrombosis and contractures. For this reason, it is particularly important to provide the most effective and efficient therapy.

 

This is exactly why recoveriX was developed–to allow a faster and better chance of recovery!

#What-Is "What is recoverix and BCI"

What is recoveriX?

recoveriX is an innovative and unique brain-computer interface (BCI) system, which was developed especially for the rehabilitation of stroke patients. It should help the patient regain the function of the upper and lower extremities, in addition to standard therapy. It can be used in the acute, sub-acute, or chronic state.

 

What is a BCI?

A BCI is a device that can allow communication or device control without movement. Instead, a BCI bypasses the brain’s normal output pathways of peripheral nerves and muscles, and detects mental activity through direct measures of brain activity (usually the EEG).

 

#How "How does recoveriX work?"
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How does recoveriX work?

 

The principle of the system is based on motor imagery, which is measured with the EEG. Since the imagination of a movement in the motor cortex produces activity almost identical to an actual movement, a BCI can use this motor imagery to influence the paretic muscles caused by stroke.

The combination of three different treatment approaches maximizes the chances of successful therapy:

 

Motor imagery

The patient is asked to imagine an upper or lower extremity movement (e.g. dorsiflexion). The signals from this motor imagery are measured with an EEG cap and passed through a biological signal amplifier to a PC or laptop. The signals are then evaluated by the recoveriX system which provides two different kinds of feedback - virtual reality and FES.
 

Advantages
  • The responsible areas of the brain are activated by the motor imagery, which can facilitate brain plasticity. Unlike conventional physiotherapy, the BCI guarantees that actual movements only occur when people imagine the corresponding movement.
  • The simultaneous activation of relevant cortical areas and peripheral neurons encourages Hebbian learning.

 

Virtual reality

If the system detects correct movement imagery, the patient gets real time feedback from an avatar. The patient must sit in front of a screen (similar to mirror therapy) that shows the avatar. For example, if the patient imagines left wrist dorsiflexion, then the avatar will perform the same movement.
 

Advantages
  • This real-time feedback is very easy to understand. If a patient imagines a movement, then the avatar performs the movement.
  • The experience is similar to watching yourself in a mirror. It can facilitate mirror neuron activation.

 

Electrical Stimulation

Two electrodes are placed on a specific muscle group – e.g. the dorsiflexors. If the user imagines the expected movement, feedback is also provided through the Functional Electrical Stimulation (FES), which activates the muscles that the patient’s damaged motor system can no longer activate through natural means.
 

Advantages
  • The patient receives clear, user-friendly feedback through active movement. Just imagine a movement, and you can see your body move accordingly.
  • The patient is motivated because the experience repeatedly reminds the patient of the desired goal state: being able to move again.

 

#TherapyExp "Therapy - Experience"

Therapy Experience and Procedure

 

A recoveriX therapy session just requires a table where you can place the system, which needs a little more space than a laptop with an extra monitor. The patient only needs to sit in front of the table. The exact position depends on which muscle areas need to be trained.

Once the patient is seated, the therapist or other system operator can load each patient’s anamnesis, including results from prior recoveriX sessions. Next, an EEG cap must be mounted on the head, and the electrodes have to be filled with a small amount of gel to produce a good signal. The monitor provides feedback about the signal quality of each electrode. The therapist can also choose which muscle groups to train.

Then, the electrodes for the FES are placed on the specific muscle group, and the pulse width, the amplitude and the frequency of the electric pulse are configured for each patient so that his/her muscel can be contracted correctly.

This setup process only takes about five to ten minutes. Each therapy run takes about ten minutes, and we recommend at least two to three runs per therapy session or more if the patient is willing. Usually, a complete therapy session should not last more than an hour.



Therapy Modes
 

Practice mode

First, practice mode should be used so the patient becomes familiar with the system. The patient learns to perform motor imagery and experience FES-based feedback. In this mode, the patient gets feedback even if the motor imagery is not performed correctly.

 

Continuous mode

This mode is for trained patients. The feedback occurs only when the subject correctly imagines the expected movement. For example, if the patient imagines wrist dorsiflexion for two seconds, the system would provide avatar and FES feedback accordingly, meaning that the feedback would end prematurely if the patient stops imagining movement early.

#WhoCanUse "Who can use recoveriX?"

Who can use recoveriX?

Inclusion and exclusion criteria

 

Most patients who survived a stroke could use recoveriX. Patients need to have enough cognitive ability to remember and act on instructions. Other important criteria for recoveriX users include:

 

  • Ability to understand instructions correctly (no Wernicke’s or global aphasia)
  • No strong spasticity (at the physician’s discretion)
  • Normal perception (no sensory deficits or neglect)
  • Ability to see
  • No metal implants in the area of FES, no stimulators (cardiac, neuro)
  • No strong Pusher-Syndrome

 

Every patient gets a complete diagnosis, which we use to determine whether RecoveriX therapy is appropriate.

 

#Components "Components of the recoveriX System"

Components of the recoveriX System

 

recoveriX is a complete, integrated, self-contained system. Aside from a table and chair, you don’t need anything other than recoveriX to conduct recoveriX therapy.

 
EEG-Cap

Measuring brain waves becomes very easy with our specially developed EEG cap. There are 16 active electrodes on the cap, which means that the signal from each electrode is pre-amplified. This provides great signal quality with fewer artifacts. More importantly, unlike conventional passive electrodes, there is no need to abrade the skin with active electrodes, which greatly reduces the time and inconvenience of preparing the EEG cap.

Biosignal amplifier

The measured brain signal is increased again with the bio-signal amplifier, and then transmitted to the PC.

FES-Functional electrical Stimulator

The system also includes 2 electrical stimulators (for the left and right extremities). The electrodes are standard gel-electrodes in different sizes, depending on the muscle group that should be stimulated.

#TherapySteps "Therapy - Step by Step"

recoveriX Therapy – Step by Step
 

  1. The therapist provides instruction to the patients. This includes describing the system and the components, and showing the movements which should be performed.
  2. During the therapy session, the patient must sit in front of a table. The patient puts on the EEG-cap and the therapist fills each electrode with gel to get a good signal. Then, the electrodes for the FES are mounted.
  3. First, practice mode should be used so the patient becomes familiar with the system. After a few runs, please change to continuous mode.
  4. After the session starts, the patient should imagine movements based on the therapist’s instructions and easy cues presented on the monitor.
  5. The system measures brain activity during the training, and gives two kinds of feedback – virtual reality with the avatar and functional electrical stimulation.
  6. During each run, the patient imagines each movement 60 times. Each imagination lasts for 8 seconds, separated by a one second break.
  7. The system saves and evaluates the results.
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The recoveriX-gym is a special therapy institution where patients can get this new therapy exclusively. In addition to recoveriX, patients can also get standard therapy to maximize their chances for successful therapy.