This thesis focuses on the development of a robotic device to be used in parallel with observational learning techniques for facilitating the recovery of the upper limb in post-stroke patients. It has been shown in the existing observational learning literature that observational practice for the execution of goal-directed single arm movements can engage the mirror neuron system and motor areas involved in learning motor actions. On the other hand, robotic-based therapy protocols have proven successful in which participants are able to learn the required perception-action skill. However, robotics have not been overly successful in the generalization of learning to other tasks and this is an essential aspect on improving performance on Activities of Daily Life (ADL). Observational learning of motor skills has been shown to produce transfer across limbs and generalization across muscle groups in the same limb, as well as transfer to perceptual tasks. Therefore, our long-term hypothesis is that a combination of interactive robotics and action observation techniques might offer a greater benefit regarding transfer to ADLs in comparison to pure robotic training. The results from this research broaden the theoretical understanding of observational learning and drive the future development of rehabilitation protocols using the combination of robotic and observational learning techniques. We hypothesize that if the application of these techniques, for non-stroke individuals, yield benefits for the learning of motor/skill actions, then such paradigm will serve as a foundation in the future development of methods for facilitating the recovery of upper limb function after stroke.

Adaptation is a fundamental property of the nervous system that underlies the maintenance of successful actions through flexible reconfiguration of sensorimotor processing. The primary aims of this thesis are 1) to investigate the computational and neural underpinnings of sensorimotor memory formation during prism adaptation (PA) in humans, and 2) how they interact with anodal transcranial direct current stimulation (a-tDCS) of the primary motor cortex (M1), in order to 3) improve efficacy of prism therapy for post-stroke spatial neglect. In chapter 4, we modify an influential state-space model of adaptation in order to characterize the contribution of short and long memory timescales to motor behaviour as sensorimotor after-effects (AEs) develop during PA. This enables us, in the multimodal 7 Tesla MRI experiment reported in chapter 5, to demonstrate that the level of M1 excitation:inhibition causally sets the relative contribution of long versus short memory timescales during PA, thus determining behavioural persistence of the AE at retention in young healthy adults. This finding offers a bridge between different levels of investigation by providing a biologically plausible neuro-computational model of how sensorimotor memories are formed and enhanced by a-tDCS. In chapter 6, we use the ageing motor system as a model of reduced GABAergic inhibition and show that the age-related decrease in M1 GABA explains why older adults demonstrate more persistent prism AEs. Taken together, these data indicate that the reduction in M1 GABAergic inhibition via excitatory a-tDCS during PA has the potential to enhance persistence of adaptation memory in both young and older adults. Informed by these results, we subsequently ask whether standard (multi-session) PA therapy combined with left M1 a-tDCS translates to greater and/or longer-lasting clinical improvements in post-stroke spatial neglect patients. In chapter 7, we compare the multimodal neuroimaging data of six neglect patients to normative data of age-matched controls. We show that in all patients, the lesion interrupted long-range frontoparietal connections, and we provide direct evidence for a pathological left dominance of activity within the lateral occipital cortex during deployment of bilateral visuospatial attention. In chapter 8, we present the behavioural performance of these patients throughout the two phases of the clinical study (i.e. before and after either PA + real M1 a-tDCS or PA + sham M1 atDCS). There was no clear effect of a-tDCS on the therapeutic effect of PA in these patients. The results of the studies presented in this thesis provide a novel insight into the neurocomputational mechanisms of sensorimotor memory formation and its modulation by a-tDCS in the healthy brain. Further investigation of how these mechanisms relate to therapeutic improvements following PA in certain neglect patients is needed.

abstract: Stroke is a leading cause of disability with varying effects across stroke survivors necessitating comprehensive approaches to rehabilitation. Interactive neurorehabilitation (INR) systems represent promising technological solutions that can provide an array of sensing, feedback and analysis tools which hold the potential to maximize clinical therapy as well as extend therapy to the home. Currently, there are a variety of approaches to INR design, which coupled with minimal large-scale clinical data, has led to a lack of cohesion in INR design. INR design presents an inherently complex space as these systems have multiple users including stroke survivors, therapists and designers, each with their own user experience needs. This dissertation proposes that comprehensive INR design, which can address this complex user space, requires and benefits from the application of interdisciplinary research that spans motor learning and interactive learning. A methodology for integrated and iterative design approaches to INR task experience, assessment, hardware, software and interactive training protocol design is proposed within the comprehensive example of design and implementation of a mixed reality rehabilitation system for minimally supervised environments. This system was tested with eight stroke survivors who showed promising results in both functional and movement quality improvement. The results of testing the system with stroke survivors as well as observing user experiences will be presented along with suggested improvements to the proposed design methodology. This integrative design methodology is proposed to have benefit for not only comprehensive INR design but also complex interactive system design in general. / Dissertation/Thesis / Doctoral Dissertation Media Arts and Sciences 2014

abstract: Motion capture using cost-effective sensing technology is challenging and the huge success of Microsoft Kinect has been attracting researchers to uncover the potential of using this technology into computer vision applications. In this thesis, an upper-body motion analysis in a home-based system for stroke rehabilitation using novel RGB-D camera - Kinect is presented. We address this problem by first conducting a systematic analysis of the usability of Kinect for motion analysis in stroke rehabilitation. Then a hybrid upper body tracking approach is proposed which combines off-the-shelf skeleton tracking with a novel depth-fused mean shift tracking method. We proposed several kinematic features reliably extracted from the proposed inexpensive and portable motion capture system and classifiers that correlate torso movement to clinical measures of unimpaired and impaired. Experiment results show that the proposed sensing and analysis works reliably on measuring torso movement quality and is promising for end-point tracking. The system is currently being deployed for large-scale evaluations. / Dissertation/Thesis / M.S. Electrical Engineering 2012

abstract: Millions of Americans live with motor impairments resulting from a stroke and the best way to administer rehabilitative therapy to achieve recovery is not well understood. Adaptive mixed reality rehabilitation (AMRR) is a novel integration of motion capture technology and high-level media computing that provides precise kinematic measurements and engaging multimodal feedback for self-assessment during a therapeutic task. The AMRR system was evaluated in a small (N=3) cohort of stroke survivors to determine best practices for administering adaptive, media-based therapy. A proof of concept study followed, examining changes in clinical scale and kinematic performances among a group of stroke survivors who received either a month of AMRR therapy (N = 11) or matched dosing of traditional repetitive task therapy (N = 10). Both groups demonstrated statistically significant improvements in Wolf Motor Function Test and upper-extremity Fugl-Meyer Assessment scores, indicating increased function after the therapy. However, only participants who received AMRR therapy showed a consistent improvement in their kinematic measurements, including those measured in the trained reaching task (reaching to grasp a cone) and in an untrained reaching task (reaching to push a lighted button). These results suggest that that the AMRR system can be used as a therapy tool to enhance both functionality and reaching kinematics that quantify movement quality. Additionally, the AMRR concepts are currently being transitioned to a home-based training application. An inexpensive, easy-to-use, toolkit of tangible objects has been developed to sense, assess and provide feedback on hand function during different functional activities. These objects have been shown to accurately and consistently track hand function in people with unimpaired movements and will be tested with stroke survivors in the future. / Dissertation/Thesis / Ph.D. Bioengineering 2012

The repetitive and sometimes mundane nature of conventional rehabilitation therapy provides an ideal opportunity for development of interactive and challenging therapeutic games that have the potential to engage and motivate the players. Different game design techniques can be used to design rehabilitation games that work alongside robotics to provide an augmentative therapy to stroke patients in order to increase their compliance and motivation towards therapy. The strategy we followed to develop such a system was to (i) identify the key design parameters that can influence compliance, prolonged activity, active participation and patient motivation, (ii) use these parameters to design rehabilitation games for robot-mediated stroke-rehabilitation, (iii) investigate the effects of these parameters on motivation and performance of patients undergoing home-based rehabilitation therapy. Three main studies were conducted with healthy subjects and stroke subjects. The first study identified the effects of the design parameters on healthy players' motivation. Using the results from this study, we incorporated the parameters into rehabilitation games, following player-centric iterative design process, which were formatively evaluated during the second study with healthy subjects, stroke patients, and health-care professionals. The final study investigated the research outcomes from use of these games in three patient's homes during a 6 weeks clinical evaluation. In summary, the research undertaken during this PhD successfully identified the design techniques influencing patient motivation and adherence as well as highlighted further important elements that contribute to maintaining therapeutic interaction between patients and the therapy medium, mainly the technological usability and reliability of the system.

It is well known that home exercise is as good as rehab center. Unfortunately, passive devices such as dumbbells, elastic bands, stress balls and tubing that have been widely used for home-based arm rehabilitation do not provide therapists with the information needed to monitor the patient’s progress, identify any impairment, and suggest treatments. Moreover, the lack of interactivity of these devices turns the rehabilitation exercises into a boring, unpleasant task. In this thesis, we introduce a family of home-based post-stroke rehabilitation systems aimed at solving the aforementioned problems. We call such applications: “Shared Haptic Environment on the Cloud for Arm Rehabilitation Exercises (SHECARE)”. The systems combine recent rehabilitation approaches with efficient, yet affordable skeleton tracking input technologies, and multimodal interactive computer environment. In addition, the systems provide a real-time feedback to the stroke patients, summarize the feedback after each session, and predict the overall recovery progress. Moreover, these systems show a new style of home-based rehabilitation approach that motivate the patients by engaging the whole family and friends in the rehabilitation process and allow the therapists to remotely assess the progress of the patients and adjust the training strategy accordingly. Two mathematical models have been presented in this thesis. The first model is developed to find the relationship between upper extremity kinematics and the associated forces/strength. The second model is used to evaluate the medical condition of the stroke patients and predict their recovery progress depending on their performance history. The objective assessments, clinical tests, and the subjective assessments, usability studies have shown the feasibility of the proposed systems for rehabilitation in stroke patients with upper limb motor dysfunction.

Background: Word retrieval deficits are a common, pervasive feature of aphasia. Semantic feature analysis (SFA) is a popular treatment technique for word retrieval impairment. Preliminary evidence of its use in small aphasia-group settings suggests improved word retrieval in discourse-based tasks with improvements in communicative informativeness (Antonucci, 2009; Falconer & Antonucci, 2012). Objective: The aim of this study was to investigate the training of SFA within discourse during a small (two-member) aphasia group treatment to ascertain if gains would be made in word retrieval abilities and communicative informativeness. Method: Two female participants with chronic aphasia, aged seventy seven and sixty eight, participated weekly in group treatment for five consecutive weeks where stimuli were used to elicit increasingly naturalistic discourse. A multiple-baseline design was used and a case series analysis conducted. Baseline measures, treatment data and data from the six week follow-up (SWFU) session were analysed using the protocols developed by Nicholas and Brookshire (1993) and Mayer and Murray (2003). Results: Both participants demonstrated certain modest gains in overall communicative informativeness but these were not maintained at the SWFU session. Gains in informativeness ranged from 12% to 13.4% for participants, which agree with improvements in other studies (Antonucci, 2009; Boyle & Coelho, 1995; Falconer & Antonucci, 2012). P2 (presented with anomic aphasia) performed better than P1 (presented with Broca’s aphasia and a component of apraxia of speech [AOS]) with regards to communicative informativeness (%CIUs) and had greater access to semantic knowledge (i.e. could access lexical forms at an improved rate). Conclusion: The small group setting may offer advantages to facilitate communication skills and increase participation in everyday conversation. Further research is needed to identify benefits for individuals with differing aphasia types and severity, optimal intensity and frequency of group treatment and the role of peer support during group interaction. Key Words Aphasia, stroke rehabilitation, word retrieval, semantic feature analysis, connected speech, discourse, group therapy, communicative informativeness, functional communication. / Dissertation (MA)--University of Pretoria, 2016. / Speech-Language Pathology and Audiology / MA / Unrestricted

Background: Stroke is one of the largest health concerns, and the number of stroke cases is increasing globally, especially in development countries. Stroke can lead to permanent disability or death, and physical therapy is vital in order to regain functions. Patients’ mental condition post-stroke is a strong predictor of the rehabilitation progress. Physical activity (PA) and exercise has shown positive effects on a biopsychosocial level and may improve patients’functionality. Objective: To investigate the level of PA, health related quality of life (HRQoL), and to clarify the relation between PA and HRQoL in people with stroke in Thailand. A secondary objective was to investigate the correlation between PA and depression in the same population. Method: PA was monitored objectively with accelerometer for 7 consecutive days, and subjectively with the Physical Activity Scale for People with Physical Disabilities. HRQoL and level of depression was assessed by index-score and Visual Analog Scale (EQ-VAS) from the EuroQoL 5-Dimension 5-Level questionnaire.  Results: The group was not physically active but experienced a high HRQoL. A significant positive correlation was found between HRQoL assessed with EQ-VAS and PA assessed both subjectively and objectively. No correlation was found between PA and depression. Conclusion: PA was associated with a higher HRQoL in stroke patients in Thailand. The participants showed an overall low PA compared to WHO guidelines, and an overall high HRQoL, including low depression. Stroke patients in Thailand should be encouraged to be more physically active, in order to gain the health benefits that PA can give. / Bakgrund: Stroke är ett av våra största hälsoproblem, och antalet strokefall ökar globalt sett,särskilt i utvecklingsländer. Stoke kan leda till permanent funktionsnedsättning eller död, och fysioterapi är avgörande för att återfå funktioner. Patientens mentala tillstånd efter en strokeincident är en stark faktor till hur effektiv rehabiliteringen blir. Fysisk aktivitet och träning har visat positiva biopsykosociala effekter och kan förbättra patientens funktion efter stroke. Syfte: Att undersöka graden av fysisk aktivitet, hälsorelaterad livskvalitet (HRQoL), och relationen mellan fysisk aktivitet och HRQoL hos strokeöverlevare i Thailand. Ett sekundärt syfte är att undersöka korrelationen mellan fysisk aktivitet och depression i samma population. Metod: Fysisk aktivitet mättes objektivt med accelerometer under sju konsekutiva dagar, och subjektivt med Physical Activity Scale for People with Physical Disabilities (PASIPD). HRQoL och depression mättes genom index-score samt Visual Analog Scale (EQ-VAS) från frågeformuläret EuroQoL 5-Dimension 5-Level (EQ-5D-5L). Resultat: Gruppen var inte fysiskt aktiv men upplevde en hög HRQoL. En signifikant positiv korrelation hittades mellan HRQoL bedömt med EQ-VAS och fysisk aktivitet genom både subjektiv och objektiv mätning. Ingen korrelation hittades mellan fysisk aktivitet och depression. Konklusion: Fysisk aktivitet var associerat med en högre HRQoL hos strokepatienter i Thailand. Deltagarna visade en övergripande låg fysisk aktivitetsgrad jämfört med WHO:s riktlinjer, och en övergripande hög hälsorelaterad livskvalité, inklusive låg depressions grad. Strokepatienter i Thailand bör bli uppmuntrade till att bli mer fysiskt aktiva, för att få de hälsofördelar som fysisk aktivitet kan ge.

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