A COGNITIVE APPROACH FOR STROKE
REHABILITATION BY ACUTE HAND
MONITORING
Hema Barathi.R1, Ramya Priyadarshini.D1, Sowmya.K1,Ramalatha M 1
Department of Information Technology, Kumaraguru College of Technology,
Coimbatore, Tamil Nadu, India
Abstract - Cognitive rehabilitation for non-traumatic
brain injuries focuses purely on retrieving the
cognitive abilities of a person after an injury or an
illness affects one’s brain. Successful rehabilitation
for stroke has often resulted from using effective
motion sensing. The existing systems include a virtual
reality environment along with a high definition
camera used for motion capture. The major
drawbacks found in these systems are that they
measure only wider hand and leg movements and are
expensive. We have developed a Cognitive approach
for Stroke Rehabilitation by acute hand monitoring,
which measures acute displacements of hand that is
used in bringing effective cognitive rehabilitation for
stroke patients at the rehab stage. Flex sensors are
attached to the fingers of the patient to measure even
a slightest jitter and corresponding magnified finger
movement is displayed which motivates the patient.
Keywords:
Cognitive
rehabilitation,
rehabilitation, hand monitoring.
stroke
1 Introduction
The three inborn skills of every human being
namely the sensory, the motor and the cognitive skills
are subjected to various experiments every now and
then as they could lead to the sprouting of new
innovative therapies and rehabilitation processes for
both traumatic and non-traumatic brain injuries.
According to the official journal of Indian Academy
of Neurology, of late, India is silently witnessing the
stroke epidemic and serious efforts must be taken to
fight against it. The currently existing stroke
rehabilitation in India primarily involves the
participation of a Neurologist, a Physiatrist, a
Psychiatrist, a Physical Therapist, an Occupational
Therapist and a Speech Therapist. The combined
contributions of all the above mentioned doctors
enable a stroke patient to undergo the rehabilitation
process successfully. This conventional rehabilitation
process involves more patience and round the clock
presence of another person which could be tiring.
According to studies made by The George
Institute for Global health, India, 87% of stroke
patients in low and middle- income countries such as
India have no access to Western form of stroke
rehabilitation as they are really expensive. On
summing up all these disadvantages on the existing
rehabilitation processes, there is a need for new,
economic friendly and easily accessible stroke
rehabilitation process and our attempt is focussed on
providing such rehabilitation process to the lower
economy stroke patients.
2
Literature survey
The survey on the existing rehabilitation
systems and techniques gave us many fruitful insights
which helped us to define our system’s objective. The
goal of Virtual Reality systems is to put the people
with disabilities in control of their own activities with
one such instance described by Norman [6]. The pros
and cons of virtual rehabilitation have been clearly
explained by Grigore [3].
However a major
disadvantage would be the attitude of the therapist
and inadequate communication between the patient
and the therapist. A SWOT analysis conducted by
Albert and Gerald [1] shows us that the major
strength is the motivation and confidence it creates in
the patients. But the acceptance of the patients and
doctors is been a major concern. The major
contributions of VR have been through the
development of games and virtual environment for
the patient with few instances such as hop hop frog
and bubble pop in [9]. Another development of VR is
the use of system from the home with remote
monitoring from the clinic [2].
A basic convenient home based virtual
reality rehabilitation system would normally consist
of a laptop or a computer with suitable user interfaces
and joy sticks [8]. Another approach is to obtain
postures from the human and create key frame
animations from poses captured from a single camera.
A very interesting approach was to use music in
stroke rehabilitation [5].Since music combines three
cognitive formats namely motor, iconic and verbal; it
promotes rehabilitation which reduces anxiety and
confusion thus improving motivation. Colour gloves
have different colour patches based on which the
motion of the hand is being monitored. According to
[10] the motion of the gloved hand is tracked by
capturing it through camera, which is later, processed
in the computer. But a drawback of using this
technology is that an exact motion of the hand can
never be tracked. Later cost efficient gloves were
developed such as one described in [7].But
[7
it had a
serious disadvantage of increasing the physical
inconvenience to the patients. Another glove
developed with the same goal was described in [4]
[4
where they used cloth glove with colour markers.
Based on the colour of thee marker the motion of the
t
hand is detected.
Figure 1: Colour gloves for stroke patients
3
Inference of the survey
From the survey on virtual rehabilitation, it was
obvious that the concept of virtual rehabilitation
works effectively to a greater extent unlike its other
othe
rehabilitation counterparts. One main inference made
from the survey is that the concepts of virtual and
mental rehabilitation are technologies that are yet to
be utilized by Indian hospitals. These technologies are
things of the present at western countries and are
proved to bee effective. So by implementing virtual
rehabilitation concept through a cognitive approach,
the treatment for paralysis patients in India can
become more effective than those physical
rehabilitation practises that are currently in existence.
exis
The survey taken on the existing virtual rehabilitation
practises lead to several interesting perspectives. One
important perspective is that all the research papers
that were considered for the survey had a very
common drawback.
All the systems pr
proposed
outwardly restricted the physical freedom enjoyed by
the patients. This in turn affects the rehabilitation
process to somee extent. Hence it was necessary to
design a system that effectively enhances the patient’s
physical freedom. The survey on data and colour
gloves contributed to most of the objective of the
project. Colour gloves and data gloves are customized
equipments which cost material as well as money.
Since 5 out of 6 people are attacked with paralysis, it
is practically impossible for patients
ents to afford the
gloves system for their rehabilitation. Thus through
this survey we conclude that we must develop a
system that is devoid of costly gloves but should
implement the functionalities that are effectively
performed by gloves.
Figure 2: Block diagram of the system
4

Overview of the system
Based on the inferences made from the
literature survey, we formed the overall block
diagram of the system which has three modules as
depicted above. The input module consists of a
microprocessor which receives the signal from the
sensor that is fixed on the patient’s hands. The
microprocessor used here is Arduino Uno and the
sensor is flex sensor.
sor. Arduino Uno was selected for
the system because of itss simplicity and its nature
of being programmer friendly. Its ADC feature and
greater compatibility makes it easier to use and
program. For the sensor, first we considered the
three axis accelerometer ADXL335 but we had a
difficulty of placing it on the patient’s
tient’s finger
because of its bulkiness. To overcome that
particular difficulty and also to achieve our
objective of maximum physical freedom to the
patient, we chose the flex sensors. Flex sensors are
made up of carbon resistors and are available in
various lengths. We used the2 inch flex
lex sensors and
the very thin structure of the sensor is apt to place
right on the fingers – on the back side of the hand.


The application is compatible with
Windows OS only.
The videos suitable for the patients must
be selected for customization of
application.
The patients are subjected to only
cognitive rehabilitation.
5
Working of the system
The efficiency of the system depends on how
well the system copes with the real time input it
receives and also how well the communication
takes place between the modules. An executable
windows form application is installed in the
attendee’s computer,, the person who is in charge of
the system.
The Arduino codes runs indefinitely until it
gets an input from the flex sensor. Once an impulse
is received, the arduino sends the angle of
movement received from the flex sensor to the
application. A sample screen shot with received
angle measure is shown below:
Figure 4: Angle Measure
Figure 3: Hardware of the system
The processing part composes of the computer
to which the Arduino is attached. The application
that takes care of the processing part is the
windows form application which is developed in
the C# language using the Windows Visual
Studio’s .NET framework. The form initiates the
communication with the arduino with a button
press event and once it receives a value from the
arduino, it triggers a video file to play.
Once the angle measure is received, the
application displays options for customization. The
screen shot is given below:
The output module is primarily a display
device which displays the video file that the
windows form has retrieved. The display device
will be of user’s choice say
y a TV screen, a
projector screen or a computer screen.
As any other real time system, our system too
has certain basic requirements as given below:
 There should be an attendant/nurse for
operating the application.
Figure 5: Customization options
The customization
stomization options are age group, skin
tone, status and gender. The options are initially
picked up and registered to the system under the
patient’s name except for the status option. The
status of the patient is determined by the angle
measure. Angle measure interval of 0 -25 is
determined to be ‘initial’ stage, 25 – 75 is the
‘middle’ stage and above 75 is the ‘final’ stage.
8
References
[1]
Albert “Skip” Rizzo, GerardJounghyun Kim(2005)
“A SWOT analysis of the field of virtual reality
rehabilitation
and
therapy,
Presence Teleoperators and Virtual Environments – Special
Issue, Vol. 14, No. 2, 119-146, April 2005.
According to this system, the video will bring
up a cognitive impulse in the patient and thus
motivates him/her to move his/her finger a few
degrees more than the actual measured movement.
By doing so, the patient is expected to get back
one’s lost motor skill over a period of time.
[2]
S.H.Brown, J.Langan, K.L.Kern, E.A.Hurvitz
“Remote monitoring and quantification of upper
limb and hand function in chronic disability
conditions”, International journal on Disability and
human development, Vol. 10, Iss. 4, Jan, 2011.
[3]
Grigore Burdea, “Keynote Address : Virtual
rehabilitation :Benefits and challenges “, First
International workshop on Virtual reality, 2002.
The developed system is a real time system that
is yet to be subjected on stroke patients. With the
help of our researches and the methods we adopted
to develop the systems, we could obviously pick up
time duration and the degree of movement of the
finger as the primary metrics of efficiency of the
system.
[4]
Jang Han Lee, JeonghunKu,WongeunCho,Won
Yong
Hahin,
InY.Kim,
Sang-Min
Lee,
Younjookang, Deog Young Kim, Taewon Yu,
Brenda K.Wiederhold, Mark D.Wiederhold, Sun
I.kim (2003) “A Virtual Reality system for the
assessment and rehabilitation of the activities of
daily living “ in Cyberpsychology & Behavior,
Vol.6, No.4, July, 2005.
7
[5]
Jimson Ngoe, TomoyaTamei, Tomohiro Shibata
“Continuous Estimation of finger joint angles
using music activation Inputs from surface EMG
signals”,www.biomedical-engineeringonline.com/content/8/1/2.
[6]
Norman Alm, John L. Arnott, Iain. R. Murray, Iain
Buchanan “ Virtual reality for putting people with
disabilities in control “, International conference on
Systems, Man and Cybernetics, Vol.2, 1174-1179,
Oct 1998.
[7]
Paul G. Kry, “Interaction capture and synthesis of
human hands”, Article, www.researchgate.net, Jan
2005.
[8]
Rosa Maria Esteves Moreira da Costa, Lu´ıs
Alfredo Vidal de Carvalho(2004) “The acceptance
of virtual reality devices for cognitive
rehabilitation. :A report of positive results with
Schizophrenia “ in Computer Methods and
Programs in Biomedicine, Vol 73, Iss. 3, 173-182,
Mar 2004.
[9]
Uri Feintuch, Maya Tuchner, AdiLorber- Haddad,
ZeevMeiner, Shimon Shiri “VirHab-A virtual
reality system for treatment of chronic pain and
disability”, Virtual reality International conference,
83-83, June 2009.
6
Results
Conclusion and future plans
The system provides a method of providing
encouragement to the afflicted patients. The
prototype has been tested for one finger which can
be expanded for all fingers and finally any
movement. This makes the system fairly suitable
for the relearning process. In addition the concept
can be extended to gaming and virtual reality
systems. Though the system that we developed is
expected to provide rehabilitation that is less
sustainable when compared to systems which
consider muscle point activation in hands, this can
be taken a starting point and more sophisticated
permanent methods can be used for chronic
patients. The further enhancement of the system
will be in terms of making the rehabilitation
process a stimulated virtual reality process.
[10] Wai-Chun Lam, Feng Zou, Taku Komura “Motion
editing with data glove “, Proceedings of the 2004
ACM SIGCHI International Conference on
advanced computer entertainment technology, 337342, Sept 2004.