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The gold-standard cognitive–behavioral therapy (CBT) for psychosis offers at best modest effects. With advances in technology, virtual reality (VR) therapies for auditory verbal hallucinations (AVH), such as AVATAR therapy (AT) and VR-assisted therapy (VRT), are amid a new wave of relational approaches that may heighten effects. Prior trials have shown greater effects of these therapies on AVH up to a 24-week follow-up. However, no trial has compared them to a recommended active treatment with a 1-year follow-up. We performed a pilot randomized comparative trial evaluating the short- and long-term efficacy of VRT over CBT for patients with treatment-resistant schizophrenia. Patients were randomized to VRT (n = 37) or CBT (n = 37). Clinical assessments were administered before and after each intervention and at follow-up periods up to 12 months. Between and within-group changes in psychiatric symptoms were assessed using linear mixed-effects models. Short-term findings showed that both interventions produced significant improvements in AVH severity and depressive symptoms. Although results did not show a statistically significant superiority of VRT over CBT for AVH, VRT did achieve larger effects particularly on overall AVH (d = 1.080 for VRT and d = 0.555 for CBT). Furthermore, results suggested a superiority of VRT over CBT on affective symptoms. VRT also showed significant results on persecutory beliefs and quality of life. Effects were maintained up to the 1-year follow-up. VRT highlights the future of patient-tailored approaches that may show benefits over generic CBT for voices. A fully powered single-blind randomized controlled trial comparing VRT to CBT is underway.

Contains fulltext : 225794.pdf (Publisher’s version ) (Open Access) Social communication and self-esteem are often affected in adults with autism spectrum disorder. Implementation and evaluation of interventions targeting social skills are challenged due to specific characteristics of autism. Intensive, valid evaluation of social skills programs is needed. In this explorative multiple case study, we examined effects and working mechanisms of dog-assisted therapy on social communication and self-esteem, by analyzing detailed observations with Monte Carlo permutation tests (testing against 10,000 random samples) and using self- and other-reports in N=6 high-functioning adults with ASD. Results showed significant positive effects on secure body posture. There was an indication of improved self-esteem and more spontaneous touching of the dog, while no convincing increase was found for verbal initiatives. Cross-correlation analyses revealed that touching the therapy dog may be an important determinant to elicit social development in Animal Assisted Therapy (AAT). Considering preliminary results, we recommend exploring underlying mechanisms more thoroughly with real-time observations, accounting for possible gender-effects.

Background Neurological injuries cause persistent upper extremity motor deficits. Device-assisted therapy is an emerging trend in neuro-rehabilitation as it offers high intensity, repetitive practice in a standardized setting. Objective To investigate the effects of therapy duration and staff-participant configuration on device-assisted upper limb therapy outcomes in individuals with chronic paresis. Methods Forty-seven participants with chronic upper extremity weakness due to neurological injury were assigned to a therapy duration (30 or 60 min) and a staff-participant configuration (1-to-1 or 1-to-2). Therapy consisted of 3 sessions a week for 6 weeks using the Armeo®Spring device. Clinical assessments were performed at three timepoints (Pre, Post, and 3 month Follow up). Results Improvements in upper limb impairment, measured by change in Fugl-Meyer score (FM), were observed following therapy in all groups. FM improvement was comparable between 30 and 60 min sessions, but participants in the 1-to-2 group had significantly greater improvement in FM from Pre-to-Post and from Pre-to-Follow up than the 1-to-1 group. Conclusions Device-assisted therapy can reduce upper limb impairment to a similar degree whether participants received 30 or 60 min per session. Our results suggest that delivering therapy in a 1-to-2 configuration is a feasible and more effective approach than traditional 1-to-1 staffing.

This chapter discussed the potential usefulness of robot-assisted therapy for motor recovery after a stroke. An overview of the available literature was performed providing up-to-date information about the use of robot-assistive technology in rehabilitation practice. The chapter discussed the rationale for the use and the different machines in terms of basic engineering principles and the related rehabilitation possibilities. Finally, clinical and rehabilitative implications of the findings were critically discussed.

Animal-assisted therapy (AAT) has been suggested to increase prosocial behavior in children diagnosed with Autism Spectrum Disorder (ASD). Out of all the animals used in AAT, dogs have been found to be the most utilized and accessible. This systematic review examines the current state of literature on canine-assisted therapy (CAT) for children with ASD based on peer-reviewed articles. Five studies met inclusion and exclusion criteria. All articles found that presence of a therapy dog was correlated with increased frequency and duration of social behavior both throughout treatment and, in the case of one study, at follow-up. However, methodological limitations such as small sample sizes and sub-optimal analytic procedures suggest that existing studies might not accurately reflect the true nature of the relationship between CAT and social behavior. Therefore, further exploration of this area of research using methodologically strong studies is warranted and necessary. Recommendations for future research are included.

Objectives Several studies have evaluated the impact of oral medication on the gut microbiome (GM) in Parkinson’s disease (PD). However, the impact of PD device-assisted therapies (DAT) on the GM remains to be investigated. We profiled acute temporal GM stability around the initiation of PD DAT. Methods The GM of 21 PD patients initiating either Deep Brain Stimulation (DBS) or levodopa-carbidopa intestinal gel (LCIG) were compared to 10 spousal healthy control (HC) subjects. 16S amplicon sequencing of the V3-V4 region of stool bacterial DNA was used to compare temporal GM stability between groups and with clinical outcome measures, including disease alternations relative to therapy initiation. GM response to therapy in the PD group was assessed by comparing pre-therapy (-2 and 0 weeks) with post-therapy initiation timepoints (+2 and +4 weeks) and HCs at baseline (0 weeks). Results Altered GM compositions were noted between the PD and HC groups at various taxonomic levels, including specific differences for DBS and LCIG therapies. Beta diversity changes were also identified across the 4 week post-treatment initiation period, implying a therapy-effect on the GM. Conclusions We present the first acute longitudinal assessment of GM response to PD DAT. The pre-treatment PD-specific GM (consistent with previous studies) was altered following DAT initiation, indicating DATs have a modulatory impact on the GM in PD.

Dog-assisted therapy (DAT) consists of an intervention, applied and supervised by duly qualified health professionals, in which the dog is an integral part of the treatment, causing behavioral changes and the health of people with different types of needs. This article aims to identify, through a literature review, the health areas capable of receiving intervention with dogs and their benefits in treatment. The results showed the possibility of implementing DAT in different configurations such as hospitals, nursing homes, clinics or schools and demonstrated the beneficial potential of this intervention for physical, mental and emotional rehabilitation. Keywords: Assisted therapy; Dog; Animal.

This work proposed the development of a game with a robot, built with Lego pieces, to make the rehabilitation treatment of children with Cerebral Palsy more effective. The aim of the game is to stimulate the motor coordination, cognition, memory and attention level of children, and to complement the activities carried out by the Neuropsychomotor Rehabilitation Program of the Nucleus of Occupational Therapy of NAMI (Nucleus of Integrated Medical Attention) of UNIFOR (The University of Fortaleza, Ceara, Brazil). The interaction between the child and the robot takes place through an Android remote control app installed on a smartphone. To validate the proposed method, five children were submitted to various sessions of activities with the robot, over a two-month period. A brain wave sensor, responsible for measuring the level of attention during the activities was employed. In addition, a questionnaire was applied to the professionals and parents of the children, in order to validate the tool proposed here. After analyzing the results, it was concluded that the robot is an effective and very promising complementary tool to assist in the rehabilitation treatment of children with Cerebral Palsy.

Tetraplegia resulting from cervical injury is the most frequent neurologic category after spinal cord injury and causes substantial disability. The residual strength of partially paralyzed muscles is an important determinant of independence and function in tetraplegia. Small improvements in upper extremity function can make a clinically significant difference in daily activities. Major advances in rehabilitation technologies over the past 2 decades have allowed testing of robotic devices in rehabilitation of motor impairments. This literature assessment provides an overview of robotic-assisted training research for improving arm and hand functions after cervical spinal cord injury.

This study aims to find out whether including robotic therapy in addition to a conventional rehabilitation program affects the quality of life, motor function, cognition, and emotional status of hemiplegic patients. Thirty-seven stroke patients recruited between April 2016 and April 2019 were included in the study. The patients were randomized into 2 groups (Robotic rehabilitation group-RR n:17, Control group n:20), RR was arranged to be 30–45 min, 5 days per week for 4 weeks. All patients were assessed at the beginning of therapy and the end of 4th week with Brunnstrom stages of motor recovery, Fugl-Meyer Assessment (FMA), handgrip strength, Purdue peg test, Minnesota manual dexterity test, Modified Ashworth Scale (MAS), Functional Independence Measure (FIM), Stroke Specific Quality of Life Scale (SS-QOL), Nottingham Extended Activities of Daily Living (NEADL) Scale, Montreal Cognitive Assessment (MoCA) and Center for Epidemiological Studies Depression Scale (CES- D). Improvements in motor function scores, spasticity, general functioning, activities of daily living, cognitive assessment were better in the robotic group when compared to the control group but this difference was not statistically significant (p > 0.05). Improvement in the CES-D in the RR-group was better in comparison to the control group (p = 0.018). Improvements in motor functions were observed after the treatment in both groups. Although RR group improved better in numbers, none of the outcomes except the CES-D scale were significant. Robotic rehabilitation provides a favorable alternative bringing slight benefits, and also is advantageous in terms of work power and psychological recovery, making its addition to conventional neurological rehabilitation effective and useful in patient management after stroke. ClinicalTrials.gov Identifier: NCT04393480

(1) Background: Currently, the scientific evidence on the benefits of assisted therapy with dogs in dementia is not clear. In this study, we want to evaluate such benefits through a randomized controlled clinical trial in multiple centers across the country. (2) Methods: The participants were people over 65 years old with dementia, residing in senior centers in Spain (n = 334). The experimental group underwent assisted therapy with dogs based on the Comprehensive Cognitive Activation Program in Dementia, for 8 months, with weekly sessions of 45 min. Data were collected at the commencement, middle, and end of the program, to evaluate the aspects using the Mini-Examination Cognitive, the modified Bartell Index, the Cornell Scale for Depression in Dementia and the Neuropsychiatric Inventory. (3) Results: The results show significant improvements in the experimental group versus the control group in the affective (T1 = p 0.000, T2 = p 0.000) and behavioral (T1 = p 0.005, T2 = 0.000) aspects, with the affective aspect displaying greater progress in participants with additional depressive (p = 0.022) or anxiety (p = 0.000) disorders, shorter institutionalization periods (r = −0.222, p = 0.004), and those undergoing complementary psychotherapy (p = 0.033) or alternative therapy (p = 0.011). (4) Conclusions: Dog therapy is effective in improving the affective and behavioral aspects of institutionalized patients with dementia.

BACKGROUND: Robot-assisted therapy (RT) has become a promising stroke rehabilitation intervention. OBJECTIVE: To examine the effects of short-term upper limb RT on the rehabilitation of sub-acute stroke patients. METHODS: Subjects were randomly assigned to the RT group (n= 23) or conventional rehabilitation (CR) group (n= 22). All subjects received conventional rehabilitation therapy for 30 minutes twice a day, for 2 weeks. In addition, the RT group received RT for 30 minutes twice a day, for 2 weeks. The outcomes before treatment (T0) and at 2 weeks (T1) and 1 month follow-up (T2) were evaluated in the patients using the upper limb motor function test of the Fugl-Meyer assessment (FMA) the Motricity Index (MI), the Modified Ashworth Scale (MAS), the Functional Independence Measure (FIM), and the Barthel Index (BI). RESULTS: There were significant improvements in motor function scales (P< 0.001 for FMA and MI) and activities of daily living (P< 0.001 for FIM and BI) but without muscle tone (MAS, P> 0.05) in the RT and CR groups. Compared to the CR group, the RT group showed improvements in motor function and activities of daily living (P< 0.05 for FMA, MI, FIM, BI) at T1 and T2. There was no significant difference between the two groups in muscle tone (MAS, P> 0.05). CONCLUSIONS: RT may be a useful tool for sub-acute stroke patients’ rehabilitation.

Assisted therapy in activities of daily life is a method in which through repeated movements, patients are able to recover gradually their range of motion. We have focused on re-learning feeding motor skills. Since patients with hemiparesis have some degree of trouble moving and present weakness on one side of their bodies, they need assistance to carry out rehabilitation tasks. In that sense, an intention-based sEMG-controlled 3 DOF upper limb exoskeleton was designed to assist them during therapy process and evaluate the progress of patients. Clinical Relevance — Robotic assistance to motor rehabilitation has acknowledged impact over effectiveness of treatment, allowing faster recovery of mobility and function, especially for patients with severe impairment.

Introduction: Robot-assisted therapy is an emerging approach that performs highly repetitive, intensive, task oriented and quantifiable neuro-rehabilitation. In the last decades, it has been increasingly used in a wide range of neurological central nervous system conditions implying an upper limb paresis. Results from the studies are controversial, for the many types of robots and their features often not accompanied by specific clinical indications about the target functions, fundamental for the individualized neurorehabilitation program. Areas covered: This article reviews the state of the art and perspectives of robotics in post-stroke rehabilitation for upper limb recovery. Classifications and features of robots have been reported in accordance with technological and clinical contents, together with the definition of determinants specific for each patient, that could modify the efficacy of robotic treatments. The possibility of combining robotic intervention with other therapies has also been discussed. Expert commentary: The recent wide diffusion of robots in neurorehabilitation has generated a confusion due to the commingling of technical and clinical aspects not previously clarified. Our critical review provides a possible hypothesis about how to match a robot with subject’s upper limb functional abilities, but also highlights the need of organizing a clinical consensus conference about the robotic therapy.

Background In the past years, robotic systems have become increasingly popular in upper limb rehabilitation. Nevertheless, clinical studies have so far not been able to confirm superior efficacy of robotic therapy over conventional methods. The personalization of robot-aided therapy according to the patients’ individual motor deficits has been suggested as a pivotal step to improve the clinical outcome of such approaches. Methods Here, we present a model-based approach to personalize robot-aided rehabilitation therapy within training sessions. The proposed method combines the information from different motor performance measures recorded from the robot to continuously estimate patients’ motor improvement for a series of point-to-point reaching movements in different directions. Additionally, it comprises a personalization routine to automatically adapt the rehabilitation training. We engineered our approach using an upper-limb exoskeleton. The implementation was tested with 17 healthy subjects, who underwent a motor-adaptation paradigm, and two subacute stroke patients, exhibiting different degrees of motor impairment, who participated in a pilot test undergoing rehabilitative motor training. Results The results of the exploratory study with healthy subjects showed that the participants divided into fast and slow adapters. The model was able to correctly estimate distinct motor improvement progressions between the two groups of participants while proposing individual training protocols. For the two pilot patients, an analysis of the selected motor performance measures showed that both patients were able to retain the improvements gained during training when reaching movements were reintroduced at a later stage. These results suggest that the automated training adaptation was appropriately timed and specifically tailored to the abilities of each individual. Conclusions The results of our exploratory study demonstrated the feasibility of the proposed model-based approach for the personalization of robot-aided rehabilitation therapy. The pilot test with two subacute stroke patients further supported our approach, while providing encouraging results for the applicability in clinical settings. Trial registration This study is registered in ClinicalTrials.gov (NCT02770300, registered 30 March 2016, https://clinicaltrials.gov/ct2/show/NCT02770300)

Background: We are today assisting to: an increasing interest to both the animal assisted therapy (AAT) and to the pet quality of life and health. The animal-assisted therapy is an alternative or complementary type of therapy that involves animals as a form of treatment. Among the goals of AAT there is to improve a patient’s psychological and physiological condition during the rehabilitation therapies. The increasing interest into the pet quality of life and health is a direct consequence of the recognition to its contribute to the society. Methods: Through an analysis of the literature the study investigated this field in order to derivate new models based on mHealth. Several studies showed the health benefits (psychological and physiological) for the human subject thanks to the AAT. Today, according to the new central position of the pet, the approach must be revised in a more general and bidirectional approach embedding the assessment of the health benefits contemporary for the two actors, human and pet. Results: The study highlights that the most commonly used types of AAT is the canine-assisted therapy (CAT). Among the most used CAT applications in psychological and physiological rehabilitation there are: the (I) co-presence during the dynamic activity (in particular the walking) and the (II) co-presence in the Area of living (mainly the home). The study focused to the CAT, introduces a conceptual model for the contemporary parameters monitoring of the two actors during the two applications (I,II) and able to provide a quantification of the utility of the CAT. It is based on to two sub-systems. The first sub-systems is a wearable mobile solution with kinematic sensors for the human and the dog monitoring in (I) during walking. The second sub-system, allowing the monitoring in (II), is based on RFID technology. Conclusions: After an analysis of the literature a new model for the CAT, based on kinematic sensors and RFID technology has been proposed and will be introduced in this field.

Purpose: The current study aimed to investigate proof-of-concept efficacy of an individualized, robotmediated training regime for people with MS (pwMS) and stroke patients. Method: Thirteen pwMS and 14 chronic stroke patients performed 36 (stroke) or 40 (pwMS) training sessions with the I-TRAVLE system. Evaluation of upper limb function was performed at baseline, after training and at 3 months follow-up. Clinical outcome measures consisted of active range of motion (ROM), Motricity Index, Jamar handgrip strength, perceived fatigue and strength, Wolf Motor Function Test (WFMT) and ABILHAND. Robot-generated outcome measures consisted of movement velocity, ROM and actual covered distance compared to straight-line distance. Results: In pwMS, significant improvements were found after training in active shoulder ROM, handgrip strength, perceived strength and WMFT activities. No significant change in clinical outcome was found in stroke patients, except for perceived strength. Significant improvement in speed and movement duration was found after training in both groups. At follow-up, clinical outcome deteriorated in pwMS and was maintained in stroke patients. Conclusions: Robot-mediated training resulted in improved movement coordination in both groups, as well as clinical improvement in pwMS. Absence of functional improvements in stroke patients may relate to severe upper limb dysfunction at baseline. The authors would like to thank the Rehabilitation Centre Blixembosch for their cooperation regarding the development of the I-TRAVLE system (2009–2012), master students Wouter Dielkens and Sander Geurts for their help with the training and data collection and Prof. Dr. Bert Op‘t Einde for project management (2008–12). This research project is supported by Interreg (INTERREG IVA-VLANED-1.58: “I-TRAVLE” project).

Oral immunotherapy (OIT) is an emerging treatment of IgE-mediated egg allergy. In the past decade, a multitude of studies have assessed the potential for egg OIT to induce clinical desensitization. The following review will evaluate the efficacy and safety of this therapy as determined by randomized controlled, non-randomized controlled and uncontrolled trials. Recent studies using reduced allergenic egg products and anti-IgE assisted therapy to improve egg OIT safety will also be discussed. Recent advances in the mechanisms underlying food OIT suggest that certain immune parameters may be helpful in monitoring response to therapy, including egg OIT. Although, egg OIT is consistently shown to be effective with regards to clinical desensitization, fewer studies have looked at persistent tolerance or sustained unresponsiveness. Limited results of long-term follow-up trials suggest that this therapy may have disease-modifying effects. In general, the comparison of studies is complicated by major differences in study designs, OIT protocols and endpoints.

The focus of this article is based on measurement of longterm effects of Dolphin Assisted Therapy (DAT) for children with developmental disorders. The use of different DAT activities are spread worldwide. They are suggested as therapeutic programs in zoos, aquariums, theme parks, marine mammal parks, and etc. However, there are still ongoing discussions about the possibility to improve illnesses and disabilities using DAT programs. Some of the critics propose that there is no proof that DAT is better than any other kind of animal assisted therapy or that it could be used as a successful long-term treatment. This article presents the fulfilment of parental expectations of DAT program, applied before the foundation of the Dolphin Assisted Therapy Center in Lithuanian Sea Museum. This DAT program was based on human-animal interaction theory and play therapy. It was never conducted in the water as well as additional consultations or other therapeutic programs during the participation in DAT were not held. 42 children with the diagnosis of developmental disorders were selected as potential participants, who had taken part in ten DAT sessions three years ago. Children were selected to meet two criteria: the first one - diagnosis of F80-F89; the second one - their parents filled a Strength and Difficulties Questionnaire (SDQ) before DAT. In the end, 30 participants were willing to participate in the research. There were 24 boys and 6 girls ranging from 3 to 10 years. Parents of these children were asked to participate in 1) telephone survey and 2) to evaluate 77 symptoms by Autism Treatment Evaluation Checklist (ATEC). Parental survey and ATEC evaluation results revealed that positive changes in behaviour, sensory and cognitive spheres occurred in 60 percent of the children. Long-term effect (due to parental opinion) occurred to one third of children who participated in the research (33.3 %). About 27 percent of parents named that DAT program had short-term effectiveness on their children and after a while these results had a tendency to decrease. Research results showed that there is a correlation (r=0.45 to r=054; p

As nursing is one of the most stressful occupations worldwide, its management warrants more attention to identify possible ways to cope with its pressures. This study aims to evaluate whether animal-assisted therapy (AAT) with the presence of a dog affects the stress level of nurses. As a stress biomarker, we used salivary cortisol level testing. Twenty female nurses (mean age: 30) in physical medicine (PMR) (n = 11) and the department of internal medicine and long-term care (IM &lt, C) (n = 9). On each of the three observed days, saliva was collected at 10 a.m. and then again after 50 min. The first sampling was performed during a normal working process without a break (Condition A), the second was carried out during a normal working process with a break of choice (Condition B), and the third sampling was performed during a normal working process with a break with AAT (Condition C). All participants were enrolled in all three interventional conditions in a randomized order. The results demonstrated the effect of a reduction of cortisol levels in Condition C, where AAT was included (p = 0.02) only in nurses recruited from the IM &lt, C department. By way of explanation, nurses from the PMR department already showed low cortisol levels at baseline. We propose including AAT with a dog in healthcare facilities where nurses are at a high risk of stress.

This paper presents an observational study conducted on the premises of the Children's Rehabilitation Center with the aim to investigate the impact of the Robot-Assisted Therapy (RAT) on nonverbal children with severe form of Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD). Through our iterative evaluation process based on observations of three children and interviews with their parents, we continuously refined behaviors of a humanoid robot NAO that are now ready to be used for research on Robot-Assisted Therapy.

Background. Robot technology for poststroke rehabilitation is developing rapidly. A number of new randomized controlled trials (RCTs) have investigated the effects of robot-assisted therapy for the paretic upper limb (RT-UL). Objective. To systematically review the effects of poststroke RT-UL on measures of motor control of the paretic arm, muscle strength and tone, upper limb capacity, and basic activities of daily living (ADL) in comparison with nonrobotic treatment. Methods. Relevant RCTs were identified in electronic searches. Meta-analyses were performed for measures of motor control (eg, Fugl-Meyer Assessment of the arm; FMA arm), muscle strength and tone, upper limb capacity, and basic ADL. Subgroup analyses were applied for the number of joints involved, robot type, timing poststroke, and treatment contrast. Results. Forty-four RCTs (N = 1362) were included. No serious adverse events were reported. Meta-analyses of 38 trials (N = 1206) showed significant but small improvements in motor control (~2 points FMA arm) and muscle strength of the paretic arm and a negative effect on muscle tone. No effects were found for upper limb capacity and basic ADL. Shoulder/elbow robotics showed small but significant effects on motor control and muscle strength, while elbow/wrist robotics had small but significant effects on motor control. Conclusions. RT-UL allows patients to increase the number of repetitions and hence intensity of practice poststroke, and appears to be a safe therapy. Effects on motor control are small and specific to the joints targeted by RT-UL, whereas no generalization is found to improvements in upper limb capacity. The impact of RT-UL started in the first weeks poststroke remains unclear. These limited findings could mainly be related to poor understanding of robot-induced motor learning as well as inadequate designing of RT-UL trials, by not applying an appropriate selection of stroke patients with a potential to recovery at baseline as well as the lack of fixed timing of baseline assessments and using an insufficient treatment contrast early poststroke.

Background: Combining cognitive behavioral therapy (CBT) for psychosis with another psychosocial intervention comprising virtual reality (VR)-assisted therapy (VRT) may improve targeted outcomes in treatment-resistant schizophrenia patients. Methods: Ten participants having followed CBT were part of our comparative clinical trial comparing VRT to CBT and were selected at the end of the study as they desired to continue to achieve improvements with VRT (CBT + VRT). Clinical assessments were administered before/after treatments and at follow-ups. Changes in outcomes were examined using linear mixed-effects models. To gain a more in depth understanding on CBT + VRT, therapists’ notes, and open interviews on a sub-group of patients were qualitatively analyzed. Results: Findings showed that the sequence of both interventions was appreciated by all patients. Several significant improvements were found throughout time points on auditory verbal hallucinations, beliefs about voices, depressive symptoms, symptoms of schizophrenia and quality of life. Although most of these improvements were in similar range to those observed in our comparative trial, effects of CBT + VRT on depressive symptoms and symptoms of schizophrenia were larger than those found for either intervention alone. Conclusion: This proof of concept is the first to merge gold-standard CBT with VRT for treatment refractory voices and to suggest a certain synergistic effect.

Background: We are today assisting to an increasing interest to the animal assisted therapy (AAT). Among the goals of the AAT there is to improve a patient’s psychological and physiological condition during the rehabilitation therapies. Several studies showed the health benefits (psychological and physiological) for the human subject thanks to the AAT. Today, according to the new central position of the pet, the approach must be revised in a more general and bidirectional approach embedding the assessment of the health benefits contemporary for the two actors, human and pet. Methods: Among the most commonly used types of AAT there is the canine assisted therapy (CAT). The study focused to the CAT and was dedicated to the design and validation of a wearable system for the assessment of physiological parameters during the walking of the two actors man and dog. A properly designed case-study involved a human (age 40; height 1.80 m; weight 80 kg) with three dogs with different sizes. It has been performed in a rectilinear walkway of 1 km of asphalt with 15 repetition with each one of the three different dogs at a speed typical for a walk. Results: The study showed a mean error ≤0.6% in the step counting. The study also showed: the feasibility to use parameters correlating the human and dog motion activity; a high acceptance of the methodology as assessed by 5 independent observers and an interesting perspectives for the future scenario of investigation of the medical scientific evidence of the approach based on the CAT. Conclusions: From a general point of view the work highlights the importance and the utility of the design and application of tool for the contemporary monitoring of the man and the dog during walking and other activities.

Motor deficit is a prominent feature among stroke survivors. Robot-assisted therapies have been proposed as a strategy to boost rehabilitation, by allowing therapy to be provided in a more reproducible and intense manner, while quantitatively monitoring patient’s improvement. However, those approaches have so far not shown superiority over conventional treatments. One potential solution to reach better outcomes would be to personalize the treatment. In this regard, a better understanding of the mechanisms underlying motor recovery is pivotal to tailor therapy to each patient. Here, we explored the cortical changes occurring during robotic training. We recorded resting-state fMRI before and after the treatment in three sub-acute post-stroke survivors, and we investigated the functional connectivity between motor regions. We observed a cortical reorganization following training, consistent with motor improvements.

Aim of the study This review classifies the kinematic measures used to evaluate post-stroke motor impairment following upper limb robot-assisted rehabilitation and investigates their correlations with clinical outcome measures. Methods An online literature search was carried out in PubMed, MEDLINE, Scopus and IEEE-Xplore databases. Kinematic parameters mentioned in the studies included were categorized into the International Classification of Functioning, Disability and Health (ICF) domains. The correlations between these parameters and the clinical scales were summarized. Results Forty-nine kinematic parameters were identified from 67 articles involving 1750 patients. The most frequently used parameters were: movement speed, movement accuracy, peak speed, number of speed peaks, and movement distance and duration. According to the ICF domains, 44 kinematic parameters were categorized into Body Functions and Structure, 5 into Activities and no parameters were categorized into Participation and Personal and Environmental Factors. Thirteen articles investigated the correlations between kinematic parameters and clinical outcome measures. Some kinematic measures showed a significant correlation coefficient with clinical scores, but most were weak or moderate. Conclusions The proposed classification of kinematic measures into ICF domains and their correlations with clinical scales could contribute to identifying the most relevant ones for an integrated assessment of upper limb robot-assisted rehabilitation treatments following stroke. Increasing the assessment frequency by means of kinematic parameters could optimize clinical assessment procedures and enhance the effectiveness of rehabilitation treatments.

Background Significant results have been shown when an upper limb robot-assisted rehabilitation is delivered to stroke patients. Objective To evaluate the effects of upper limb robot-assisted rehabilitation on motor recovery in stroke patients who underwent a treatment based on a haptic device. Methods Thirty-nine stroke patients (twenty-three subacute and sixteen chronic) underwent rehabilitation training by using MOTORE/Armotion haptic system. Thirteen healthy subjects were recruited for comparison purpose.The following clinical outcome measures were used: Chedoke-McMaster Stroke Assessment, Modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FM), Medical Research Council, Motricity Index (MI), Box and Block Test (B&B) and Modified Barthel Index (mBI).The following parameters were computed: mean speed, maximum speed, mean time, path length, normalized jerk, mean force, mean error, mean energy expenditure and active patient-robot interaction percentage.The assessments were carried-out before and after treatment. Results Significant changes were observed in both groups in the FM, MI, B&B and mean speed. Significant changes were observed in mBI, mean time, mean force, mean energy expenditure and active patient-robot interaction percentage in subacute stroke patients. In chronic stroke patients significant changes were found on the MAS-elbow. Conclusions The haptic device used is at least as effective as an existing device used in similar studies.

Objectives: The purpose of this study is to assess the effectiveness of PARO assisted therapy for Autism Spectrum Disorder (ASD) in the child and adolescent psychiatric ward. Methods: In the Child and Adolescent Psychiatry Ward of Shikoku Medical Center for Children and Adults, we put PARO near the door of the nurse station and told the inpatients to play with it freely in the hall of the ward after getting permission from the staff. The interaction between patients and PARO was observed. Results: It was thought to be useful for same patients with ASD in developing good communication or in reduction of impulsive behaviors or anxiety. However, others hated it for some features such as its big eyes or a slight drive noise. Conclusions: Before animal type robot-assisted therapy is introduced as a tool for the patients with ASD, the kind of patients who are benefitted by this approach and how the approach would work in the treatment must be clarified.

Background. Several pilot studies have evoked interest in robot-assisted therapy (RAT) in children with cerebral palsy (CP). Objective. To assess the effectiveness of RAT in children with CP through a single-blind randomized controlled trial. Patients and Methods. Sixteen children with CP were randomized into 2 groups. Eight children performed 5 conventional therapy sessions per week over 8 weeks (control group). Eight children completed 3 conventional therapy sessions and 2 robot-assisted sessions per week over 8 weeks (robotic group). For both groups, each therapy session lasted 45 minutes. Throughout each RAT session, the patient attempted to reach several targets consecutively with the REAPlan. The REAPlan is a distal effector robot that allows for displacements of the upper limb in the horizontal plane. A blinded assessment was performed before and after the intervention with respect to the International Classification of Functioning framework: body structure and function (upper limb kinematics, Box and Block test, Quality of Upper Extremity Skills Test, strength, and spasticity), activities (Abilhand-Kids, Pediatric Evaluation of Disability Inventory), and participation (Life Habits). Results. During each RAT session, patients performed 744 movements on average with the REAPlan. Among the variables assessed, the smoothness of movement ( P < .01) and manual dexterity assessed by the Box and Block test ( P = .04) improved significantly more in the robotic group than in the control group. Conclusions. This single-blind randomized controlled trial provides the first evidence that RAT is effective in children with CP. Future studies should investigate the long-term effects of this therapy.

Dolphin-assisted therapy has frequently been criticized for a lack of empirical results and theoretical foundation. In this study, results from an innovative dolphin-assisted therapy program for children with disabilities are presented. The therapeutic program is based on a sophisticated framework and developed with reference to previous findings about special education interventions. Parental involvement was integrated purposefully into the dolphin–child interaction to initiate an improvement in parent–child interactions. The effectiveness of this approach was supported in a controlled pretest-posttest design with matched samples. Pre-testing was conducted 4 weeks before dolphin-assisted therapy commenced, and post-testing occurred 4 weeks and 6 months after it finished. In total, 47 children with disabilities (Down syndrome, physical or mental retardation) and their parents and pedagogic-therapeutic staff participated in the study. The results of the parental questionnaires showed stable, positi...

The study investigates the dynamic of verbal and non-verbal communication in the context of Animal Assisted Therapy for children with special needs, using ethological and sociometrical methods (i.e. focal individual sampling, ethogram and sequential behavior analysis). The study followed the evolution of a 5-year-old boy with mild mental retardation, ADHD symptoms and a very low level of verbalization, through one year of weekly AAT (dog assisted therapy) sessions. Each session had an average duration of 20 min. Behavioral analysis of the video recorded materials indicated a significant progress in speech development and a decrease of hyperactive symptoms. The implementation of the proposed methods (focal animal sampling and Social Network Analysis) allowed us to objectively analyze the complex interactions between the behavioral sequences, which usually can be very difficult to be extracted in a quantitative manner. The results supported our hypotheses in terms that the complexity of verbal communication increased throughout the five sessions of dog-assisted therapy, which were selected for the behavioral data analysis. Nonverbal communication towards the dog and the handler was also diversified towards the last session.

[Purpose] The aim of this study was to examine the effects of upper limb robot-assisted therapy in the rehabilitation of stroke patients. [Subjects and Methods] Fifteen stroke patients with no visual or cognitive problems were enrolled. All subjects received robot-assisted therapy and comprehensive rehabilitation therapy for 30 minutes each. The experimental group received a conventional therapy and an additional half hour per weekday of robot therapy. The patients participated in a total of 20 sessions, each lasting 60 minutes (conventional therapy 30 min, robot-assisted therapy 30 min), which were held 5 days a week for 4 weeks. [Result] The patients showed a significant difference in smoothness and reach error of the point to point test, circle size and independence of the circle in the circle test, and hold deviation of the playback static test between before and after the intervention. On the other hand, no significant difference was observed in the displacement of the round dynamic test. The patients also showed significant improvement in the Fugl-Meyer Assessment and Modified Barthel Index after the intervention. [Conclusion] These kinematic factors can provide good information when analyzing the upper limb function of stroke patients in robot-assisted therapy. Nevertheless, further research on technology-based kinematic information will be necessary.

BackgroundOne in four patients with schizophrenia responds poorly to antipsychotic medication, continuing to hear persecutory auditory hallucinations. Patients who are able to sustain a dialogue with their persecutor feel much more in control.AimsTo develop a computerised system that enables the patient to create an avatar of their persecutor. To encourage them to engage in a dialogue with the avatar, which the therapist is able to control so that the avatar progressively yields control to the patient.MethodAvatar therapy was evaluated by a randomised, single blind, partial crossover trial comparing the novel therapy with treatment as usual (TAU). We used three main outcome measures: (a) the Psychotic Symptom Rating Scale (PSYRATS), hallucinations section; (b) the Omnipotence and Malevolence subscales of the Revised Beliefs About Voices Questionnaire (BAVQ-R); and (c) the Calgary Depression Scale (CDS).ResultsThe control group showed no change over time in their scores on the three assessments, whereasthe novel therapy group showed mean reductions in the total PSYRATS score (auditory hallucinations) of 8.75 (P = 0.003) and in the BAVQ-R combined score of omnipotence and malevolence of the voices of 5.88 (P = 0.004). There was no significant reduction in the CDS total score for depression. For the crossover control group, comparison of the period of TAU withthe period ofavatar therapy confirmed the findings of the previous analysis. The effect size of the therapy was 0.8.ConclusionsAvatar therapy represents a promising treatment for medication-resistant auditory hallucinations. Replication with a larger sample is required before roll-out to clinical settings.

Technology aided measures offer a sensitive, accurate and time-efficient approach for the assessment of sensorimotor function after neurological insult compared to standard clinical assessments. This study investigated the sensitivity of robotic measures to capture differences in planar reaching movements as a function of neurological status (stroke, healthy), direction (front, ipsilateral, contralateral), movement segment (outbound, inbound), and time (baseline, post-training, 2-week follow-up) using a planar, two-degrees of freedom, robotic-manipulator (H-Man). Twelve chronic stroke (age: 55 ± 10.0 years, 5 female, 7 male, time since stroke: 11.2 ± 6.0 months) and nine aged-matched healthy participants (age: 53 ± 4.3 years, 5 female, 4 male) participated in this study. Both healthy and stroke participants performed planar reaching movements in contralateral, ipsilateral and front directions with the H-Man, and the robotic measures, spectral arc length (SAL), normalized time to peak velocities (TpeakN), and root-mean square error (RMSE) were evaluated. Healthy participants went through a one-off session of assessment to investigate the baseline. Stroke participants completed a 2-week intensive robotic training plus standard arm therapy (8 × 90 min sessions). Motor function for stroke participants was evaluated prior to training (baseline, week-0), immediately following training (post-training, week-2), and 2-weeks after training (follow-up, week-4) using robotic assessment and the clinical measures Fugl-Meyer Assessment (FMA), Activity-Research-Arm Test (ARAT), and grip-strength. Robotic assessments were able to capture differences due to neurological status, movement direction, and movement segment. Movements performed by stroke participants were less-smooth, featured longer TpeakN, and larger RMSE values, compared to healthy controls. Significant movement direction differences were observed, with improved reaching performance for the front, compared to ipsilateral and contralateral movement directions. There were group differences depending on movement segment. Outbound reaching movements were smoother and featured longer TpeakN values than inbound movements for control participants, whereas SAL, TpeakN, and RMSE values were similar regardless of movement segment for stroke patients. Significant change in performance was observed between initial and post-assessments using H-Man in stroke participants, compared to conventional scales which showed no significant difference. Results of the study indicate the potential of H-Man as a sensitive tool for tracking changes in performance compared to ordinal scales (i.e., FM, ARAT). MOH (Min. of Health, S’pore) NMRC (Natl Medical Research Council, S’pore) Published version

A growing awareness of the potential for machine-mediated neurorehabilitation has led to several novel concepts for delivering these therapies. To get from laboratory demonstrators and prototypes to the point where the concepts can be used by clinicians in practice still requires significant additional effort, not least in the requirement to assess and measure the impact of any proposed solution. To be widely accepted a study is required to use validated clinical measures but these tend to be subjective, costly to administer and may be insensitive to the effect of the treatment. Although this situation will not change, there is good reason to consider both clinical and mechanical assessments of recovery. This article outlines the problems in measuring the impact of an intervention and explores the concept of providing more mechanical assessment techniques and ultimately the possibility of combining the assessment process with aspects of the intervention.

Although a number of research studies have examined the effects of robot-assisted movement therapy for adults with motor impairments following stroke, use of this technology for children with neurologically-based movement disorders is just beginning. Conventional rehabilitation methods are i nsufficient in meeting children's needs for intensive motor learning experiences. Therapy for children with moderate to severe upper limb motor impairments is particularly challenging, because of their reluctance to engage in challenging and repetitive upper limb exercise and frequent developmental disregard for using the paretic arm during functional tasks. In an effort to adapt robot-assisted movement therapy for children with moderate to severe hemiplegia due to cerebral palsy (CP), we developed robotic therapy that was engaging and cognitively challenging for children, and that provided intensive s ensorimotor practice during goal directed reaching activities. This is a review of how we adapted robotic therapy for children with hemiplegia, our selection of outcome measures, and a brief summary of study findings. Our initial work suggests that robot-assisted t herapy can be readily adapted and has good potential for improving motor performance of children with hemiplegic cerebral palsy.

The goal of this study was to test if dolphin-assisted therapy could be an effective therapeutic intervention for children with significant social and communication disabilities. Furthermore, it was crucial to determine the relative importance of the dolphin and the parent consultation factors implicit in the therapy. The method employed was a before-and-after comparison of three control groups and one experimental group. In the experimental group, all three aspects of the therapeutic intervention—interaction with dolphins, parent counseling and a curative, relaxed environment—were included. Control group 1 (outpatient therapy group) was limited to just interaction with dolphins. In control group 2 (farm animal group), the parents were counseled after the children interacted with farm animals (which replaced dolphins). Control group 3 received no treatment. The post-treatment parent questionnaire results revealed therapeutic success in the areas of both productive and receptive language, processin...

Occupational therapy has a history of using animals as part of the therapeutic medium. Few studies have investigated animal assisted therapy for individuals with autism whose profound impairments have been seen in social interaction, communication, and restricted interests. This study explored the feasibility of using the Thai elephant in a treatment program. The purposes of the study were to (1) create a new treatment program using a Thai elephant to assist the individual with autism; and (2) examine theeffect of the program and the feasibility of using it with individuals with autism. The new treatment program was created by a team of occupational therapists and elephant experts. The participants’ performance was examined before and after the treatment program. The results showed that the participants improved in adaptive behaviour, sensory processing, postural control, and balance after receiving three weeks of the programe. Parents also reported satisfaction with the program results.

Dolphin-Assisted Therapy (DAT) is an increasingly popular choice of treatment for illness and developmental disabilities by providing participants with the opportunity to swim or interact with live captive dolphins. Two reviews of DAT (Marino and Lilienfeld (1998) and Humphries (2003)) concluded that there is no credible scientific evidence for the effectiveness of this intervention. In this paper, we offer an update of the methodological status of DAT by re- viewing five peer-reviewed DAT studies published in the last eight years. We found that all five studies were methodologically flawed and plagued by sev- eral threats to both internal and construct validity. We conclude that nearly a decade following our initial review, there remains no compelling evidence that DAT is a legitimate therapy or that it affords any more than fleeting improve- ments in mood.

Evidence of superiority of robot training for the hand over classical therapies in stroke patients remains controversial. During the subacute stage, hand training is likely to be the most useful.To establish whether robot active assisted therapies provides any additional motor recovery for the hand when administered during the subacute stage (4 months from event) in a Mexican adult population diagnosed with stroke.Compared to classical occupational therapy, robot based therapies for hand recovery will show significant differences at subacute stages.A randomized clinical trial.A between subjects randomized controlled trial was carried out on subacute stroke patients (n = 17) comparing robot active assisted therapy (RT) with a classical occupational therapy (OT). Both groups received 40 sessions ensuring at least 300 repetitions per session. Treatment duration was (mean ± std) 2.18 ± 1.25 months for the control group and 2.44 ± 0.88 months for the study group. The primary outcome was motor dexterity changes assessed with the Fugl-Meyer (FMA) and the Motricity Index (MI).Both groups (OT: n = 8; RT: n = 9) exhibited significant improvements over time (Non-parametric Cliff's delta-within effect sizes: dwOT-FMA = 0.5, dwOT-MI = 0.5, dwRT-FMA = 1, dwRT-MI = 1). Regarding differences between the therapies; the Fugl-Meyer score indicated a significant advantage for the hand training with the robot (FMA hand: WRS: W = 8, p0.01), whilst the Motricity index suggested a greater improvement (size effect) in hand prehension for RT with respect to OT but failed to reach significance (MI prehension: W = 17.5, p = 0.080). No harm occurred.Robotic therapies may be useful during the subacute stages of stroke - both endpoints (FM hand and MI prehension) showed the expected trend with bigger effect size for the robotic intervention. Additional benefit of the robotic therapy over the control therapy was only significant when the difference was measured with FM, demanding further investigation with larger samples. Implications of this study are important for decision making during therapy administration and resource allocation.

Ankle sprains are very common, especially in sports activities. Accurate assessment of ankle ligament strain behavior is crucial in understanding ankle function and optimizing ankle rehabilitation programs. This study proposed an in-vivo lateral ankle ligament strain assessment technique for potential use in robot-assisted therapy. It consists of two phases: real-time identification of ankle joint and subtalar joint orientations and simulation of lateral ankle ligament strain behavior. A healthy participant conducted robot-assisted rehabilitation exercises and the results compared to a kinematic model. The model was found to be realistic, leading to the conclusion that this method may be appropriate for determining lateral ankle ligament strain in robot-assisted therapy.

This study addressed the design, construction and instrumentation of an active hand orthosis driven by electromyographic (EMG) signals captured over the arm. The EMG signals were classified using a static neural network (SNN) supplied by the momentum learning scheme. The orthosis was actuated with a collection of direct current motor commanded by distributed control strategy based on the so-called twisting controller. The orthosis was interfaced to a computer where a special class of graphic user interface (GUI) was implemented. This GUI contains a sequence of suggested exercises that patient wearing the orthosis must try to develop. The orthosis was implemented and the proposed controller forced the tracking of the reference trajectories supplied by the GUI. The orthosis was evaluated in simulation to adjust the EMG signal classifier as well as the controller gains. A real orthosis was constructed and controlled using the gains obtained at the simulation stage.

The main goal of this study is to present preliminary results on the effects of combined transcranial direct current stimulation and wrist robot-assisted therapy in subacute stroke patients. Twelve subacute stroke patients participated in the study and were randomly assigned to the experimental (real stimulation on the affected hemisphere) or control group (sham stimulation). Clinical scales were used for assessment. Kinematic parameters measured at the robot end-effector. Outcome clinical measures show a significant decrease in motor impairment after the treatment in both groups. Kinematic data show, though not significant, improvements between admission and discharge in four selected directions in both groups. Our results do not show any additional advantage of the transcranial direct current stimulation over the wrist robot-assisted therapy.

Animal-assisted therapy (AAT) has been shown to reduce the loneliness of residents in long-term care facilities (LTCFs). In this study, we determined the relative contribution of socialization (human–human bonding) and human–animal bonding as mechanisms by which AAT reduces loneliness. Residents in LTCFs volunteering for AAT were randomized to receive AAT as individuals (Individual) or in groups of two to four (Group). Individual AAT was used as a measure of animal–human bonding, and Group AAT was used as a measure of the combination of animal–human bonding and socialization. Any greater effect of Group AAT in comparison to Individual AAT would be ascribed to socialization. Thirty-seven residents of LTCFs, who were cognitively intact, volunteered for AAT, and scored as significantly lonely on the UCLA Loneliness Scale (Version 3), were studied. Six weeks of AAT, one 30-minute session per week, in an individual or group setting was performed, with posttesting during week five. Two residents dropped...

Background: Research has shown there are three different recognised levels of processing involved in spoken word production: the semantic level, the lexical level, and the phonological level. All of these influence the naming performance of anomic patients. However, there is disagreement regarding the most appropriate strategies for the treatment of anomic problems (repetition, lexical‐phonological cueing, semantic cueing, or a combination of all three). The use of computers seems to offer considerable advantages for the daily work of speech therapists, however there is still discussion as to whether or not computers can help patients achieve goals in therapy, and whether computers really can assist therapists in helping their patients to reach their full potential. Aims: This report describes the Computer‐assisted Anomia Rehabilitation Program (CARP) designed to be used by a speech therapist working with anomic patients. The program uses semantic, phonological, written, and semantic/phonological cueing p...

The goal of this study is to evaluate the effects of robot-assisted upper limb therapy in subacute and chronic stroke patients using a set of kinematic parameters evaluated during each of the first 15 rehabilitation sessions. Twenty-four post-stroke subjects, twelve subacute and twelve chronic, participated in the study. A 2 DOFs robotic system was used for upper limb training. Kinematic parameters related to the speed and smoothness measured at the robot's end-effector were computed. Outcome clinical measures show a decrease in motor impairment at half-treatment both in chronic and subacute patients. Significant improvements in kinematic parameters within the first 15 sessions were observed only in subacute patients.