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With the advent of an aging society, the number of people suffering from degenerative diseases, which often lead to communication disorders such as motor speech disorders (MSDs). Intensive and repeated practice is essential for individuals with MSDs. Because of work overload, speech and language therapists (SLTs) might cope with the excess load of treatment, which may lead to reduce of rehabilitation effects. Nowadays smart mobile devices such as the iPad and tablet PC have changed the way of therapy. Therefore, this study proposes the feasibility of assistive technology intervention through the user-centered design process in MSDs treatment. First, it uses Delphi expert assessment interviewing the SLTs to realize how they work about MSDs. Second, the SLTs define the weighting of requirements using the analytic hierarchy process. The most two important two criteria are: evaluate willing to practice, and easy to review the home exercises. Third, it transfers the requirements into design criteria and develop the assistive APP, MOUTH EXERCISE. SLTs can select and demonstrate correct video to the individuals instead of exercising their oral muscles. Finally, SLTs participate the usability evaluation to validate the APP. They suggest that MOUTH EXERCISE can not only as an assistive manner of speech therapy, but also reduce the workload of them. It concludes that the developed APP is a useful tool for STLs. In the future, it will develop home practice mode to enhance the rehabilitation motivation of individuals.

Parkinson’s disease (PD) is a progressive and incurable neurodegenerative disease. If PD can be diagnosed and treated as early as possible, not only can it effectively delay the degeneration of the brain, but also further maintain the follow-up quality of patients’ life. This study focuses on developing an early vocal screening service of PD to detecting the stage of PD and helps healthy people to do an early screening of the possibility of developing PD. There are four patients with PD and three neurology physicians that were interviewed. In addition, a questionnaire survey of the healthy people on the acceptance of early screening services. For patients, they have to spend a long time to confirm the diagnosis during the observation period of suspected PD. The existing diagnosis is very dependent on the physician’s expertise and clinical experience, especially the initial diagnosis. Thus, it delays the golden period of delaying correction, and early administration and treatment. Healthy people with the condition of PD likely possess little knowledge about it. But, they were willing to try the service of early screening to see whether they are suffering from suspected PD symptoms in a few minutes. According to the results, an early vocal screening service model is developed. The possibility of contracting PD can be detected as early as possible by subtle changes in speech as shown in the voice recording of 3 to 5 minutes left by healthy people, such as trembling, breathing pause, and other factors that are not easily identified by voice detection analysis.

Similar to many other countries in the world, the elderly population in Taiwan is now growing rapidly. Some older adults are found to have difficulty controlling their emotion, which may later develop into psychological diseases such as anxiety disorder. Therefore, emotional control is an important issue for elderly citizens. This study proposed a wearable biofeedback emotional control device, FeelVest, which integrates electrocardiography acquisition with heart rate variability analyzing techniques to detect user’s emotion. When a user is nervous and unstable, FeelVest would analyze the emotional state of the user. If the user’s emotional condition is judged as abnormal, the control module would remind the user to relax through vocal notification, or broadcast relaxation melodies to ease the user’s nerve. With this vest, older adults are able to monitor and regulate their own emotion and have a healthier life style.

To evaluate whether a bout of leg cycling in patients with stroke reduces muscle tone and to determine whether neuromuscular functional electrical stimulation (FES) to the affected leg during cycling is more effective than cycling without FES.Within-subject comparison.University hospital.Patients with stroke (N=16; age range, 42-72y;8wk poststroke) with hypertonia in the affected leg.Subjects' affected leg (1) performed cycling exercise with the assistance of FES (assisted-cycling session) and (2) performed cycling exercise without the assistance of FES (nonassisted-cycling session). Subjects sat in a specially designed wheelchair positioned on a resistance-free roller for each 20-minute session.Changes in muscle tone pre- and posttest session were compared by using the Modified Ashworth Scale and the pendulum test (relaxation index and peak velocity).Modified Ashworth Scale scores were significantly lower (P.05) and relaxation index and peak velocity values were significantly higher (P.05) after both sessions. Changes in Modified Ashworth Scale scores, relaxation index, and peak velocity values showed a significant (P.05) difference between the 2 sessions, and assisted cycling reduced hypertonia more than nonassisted cycling.The hypertonia of patients with stroke showed a significant decrease immediately after a bout of leg-cycling exercise. FES-assisted leg cycling was better than nonassisted cycling for reducing hypertonia.

Objective: To determine whether short-term propulsion of a functional electrical stimulation-assisted leg-cycling wheelchair (FES-LW) in patients with stroke can reduce spasticity of the affected leg and whether FES has additional effects on reducing spasticity. Design: Within-subject comparison. Subjects: A total of 17 patients after stroke were recruited from the university hospital. Methods: Subjects propelled 2 leg-cycling wheelchairs (the FES-LW and the LW) and a manual wheelchair along an oval pathway. The Modified Ashworth Scale (MAS), H reflex/maximal M response (H/M ratio) and relaxation index were used to evaluate the immediate effects on leg spasticity. The changes in MAS, H/M and relaxation index were used to evaluate the effect of FES in comparing 2 leg-cycling wheelchairs. Results: The MAS and H/M ratio were significantly decreased and the relaxation index significantly increased by FES-LW and LW usage. For subjects with higher muscle tone, significant lowering of the changes in MAS, H/M ratio and higher relaxation index were found for FESLW usage compared with LW usage. Conclusion: Leg spasticity is reduced after short-term propulsion of the FES-LW and LW. The application of FES has an additional effect on reducing spasticity in subjects with higher muscle tone.

Hemiplegic stroke patients are physically able to use only one arm and leg, those on the unaffected side, to propel and steer a manual wheelchair; therefore, it is difficult for them to use current manual wheelchairs. Although there have been a number of outstanding studies on wheelchair propulsion, very few have dealt with the wheelchair propulsion problems for stroke patients, whose propulsion styles are greatly different from users with healthy upper limbs. The purpose of this study was to develop a novel wheelchair for stroke patients based on their needs. A planar four-bar chain mechanism was introduced to develop the new wheelchair, and a clinical evaluation in a rehabilitation center was also done to evaluate the chair's usability. The prototype we developed allows stroke patients to use their legs and arms together to propel the wheelchair, and permits them to steer the wheelchair safely and efficiently. Eleven stroke patients with right hemiplegia were recruited to clinically evaluate the newly designed prototype, the unilaterally propelled wheelchair (UPW), in a comparison with a commercial two-handrim propelled wheelchair (TPW). The results revealed that the velocity, deviation frequency, and deviation period of the UPW were superior to those of the TPW. We concluded that it is easier, safer, and more efficient for hemiplegic stroke patients to use the UPW than the TPW. Relevance to industry The manual wheelchair has many demonstrable benefits for users who have mobility problems and sufficient upper-limb strength to propel one. However, it can be difficult for stroke patients to propel current manual wheelchairs. This study offers an innovative wheelchair, designed with the needs of hemiplegic stroke patients in mind, that offers improved efficiency and safety, thereby promoting independent living.

Stroke survivors might lose their walking and balancing abilities, but many studies pointed out that cycling is an effective means for lower limb rehabilitation. However, during cycle training, the unaffected limb tends to compensate for the affected one, which resulted in suboptimal rehabilitation. To address this issue, we present a Virtual Reality-Cycling Training System (VRCTS), which senses the cycling force and speed in real-time, analyzes the acquired data to produce feedback to patients with a controllable VR car in a VR rehabilitation program, and thus specifically trains the affected side. The aim of the study was to verify the functionality of the VRCTS and to verify the results from the ten stroke patients participants and to compare the result of Asymmetry Ratio Index (ARI) between the experimental group and the control group, after their training, by using the bilateral pedal force and force plate to determine any training effect. The results showed that after the VRCTS training in bilateral pedal force it had improved by 0.22 (p=0.046) and in force plate the stand balance has also improved by 0.29 (p=0.031); thus both methods show the significant difference.

People with neurological damage may develop physical impairments such as hemiplegia, and interlimb coordination deficits are common among stroke patients. Leg-cycling exercise is an alternative and symmetrical bilateral leg movement. However, stroke patients are generally reluctant to attend leg-cycling trainings. Virtual reality (VR) is a new and promising computer-based technology to promote leg-cycling training among stroke patients. A new force-detect leg-cycling training system which combined with a virtual community environment has been developed by our research team. Two healthy subjects were recruited to attend the preliminary case study. The results showed that the two healthy users could successfully operate the VR leg-cycling training system and control the direction of the virtual car in the virtual environment. In the next stage, patients with interlimb coordination deficits should be recruited in the training courses so as to verify the rehabilitative effect of the VR leg-cycling system.

Adequate reminding would facilitate the management of emotion. That would prevent out control of destructive rage, and facilitate the emotion expression and balance. This study developed a portable system for emotion assessment basing on HRV method, which would feedback to user with proper advices for help the management of emotion. The system is constructed with an embedded system and a PDA phone, which firstly measures the ECG signal, and then analyzes HRV, finally presents the emotion status.

The aim of this study is to determine whether short term functional electrical stimulation (FES)-assisted cycling training can affect the postural control of stroke patients, and whether the application of FES can enhance the effect of cycling training. 20 stroke patients were randomly assigned to the FES-cycling group (FES-CG) or the cycling group (CG). Measurements were completed before and immediately after each 20 min training sessions. The measurements included a balance test (to quantify the postural control ability), a Hoffmann's reflex/motor response ratio (H/M ratio) test and a pendulum test (to quantify the muscle tone). In the balance test, some parameters in all directions exhibited significant intervention effects between the FES-CG group and the CG group. The H/M ratios (p=.014; .005, FES-CG and CG respectively) and relaxation index (p=.005; .047, FES-CG and CG respectively) revealed significant difference between FES-CG and CG group. The change ratios of directional control in the forward direction and H/M ratio revealed significant difference (p=.022; .015) between FES-CG and CG among subjects with higher muscle tone. The stroke subjects' postural control was improved while their muscle tone was reduced after the 20 min cycling training program both with and without FES. We conclude that cycling training, with or without FES may reduce spasticity in stroke patients. The application of FES in cycling exercise was shown to be more effective in stroke patients with higher muscle tone.

Manual wheelchairs are an important mobility device for hemiplegic stroke patients, but understandably difficult to operate. A novel mobility device termed the functional electrical stimulation-assisted leg-propelled wheelchair (FES-LW) was proposed and a field test conducted to evaluate its clinical performance by comparison against a manual wheelchair (MW).A total of 20 hemiplegic patients were recruited from the National Cheng Kung University Hospital. They were instructed to successively propel the FES-LW and MW comfortably, as fast as possible, in along an oval pathway. The finish time, deviation frequencies, deviation percentage, physiological cost index (PCI), and modified Ashworth scale (MAS) of affected ankle were measured and compared.Subjects can propel the FES-LW with 40.1% less finish time (P=0.003); 23.7% lower deviation frequencies (P=0.009) and 36.7% lower deviation percentage (P=0.001); and 17.7% lower PCI (P=0.022) than the MW. In addition, the MAS of the affected ankle was noticeably reduced (P=0.002) after propelling the FES-LW.The FES-LW showed better controllability, cardiopulmonary response and positive effects on reducing spasticity versus the MW. The FES-LW is a suitable alternative to a MW for the needs of hemiplegic stroke patients.

OBJECTIVE To evaluate the controllability of, and physiological responses to, 2 newly designed unilaterally-propelled wheelchairs for patients with hemiplegia. DESIGN Within-subject comparison. SUBJECTS A total of 15 patients after stroke were recruited from the rehabilitation centre of Chung Shan Medical University, Taichung, Taiwan. METHODS Two newly designed wheelchairs (an ankle-propelled wheelchair and a knee-propelled wheelchair) were compared with a commercially available 2-hand-rim propelled wheelchair. Patients propelled the 3 wheelchairs along an oval pathway. Videotapes were made for analysis. The following parameters: total propulsion time, deviation frequency, deviation percentage, physiological cost index (VO2) and rating of perceived exertion were measured and compared. RESULTS The knee-propelled wheelchair gave the best results for controllability, cardiopulmonary and perceived exertion. However, the gear ratio of this wheelchair's force transmission was fixed, and some patients felt that its propulsion was heavy when starting off. CONCLUSION The knee-propelled wheelchair showed good controllability and physiological responses for hemiplegic patients. If some details were improved, it would suitable for use by patients with hemiplegia.

People with post-stroke neurological damage may be left with physical impairments deeply affecting their daily life. Using a manual wheelchair is a common manner of locomotion for stroke patients in recovery stage. However, this kind of wheelchair is poor clinical considered and difficult for them to use. A functional electrical stimulation system with cycling system wheelchair (FCW) for hemiplegic patients was designed and proposed in this study. Hemiplegic patients can propel the FCW using both the unaffected and affected legs and can steer the wheelchair efficiently. A clinical evaluation was conducted to assess both the chair's maneuverability and user-satisfaction with the chair. A total of 12 participants were recruited to evaluate the FCW by comparing with a commercially available manual wheelchair (MW). The results inducted that the FCW was more maneuverable than the MW. In addition, participants were more satisfied with the FCW than with the MW. Therefore, we concluded that it is easier and more efficient for hemiplegic stroke patients to operate the FCW than the MW.