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Intensive Language Action Therapy (ILAT) is a short-term aphasia therapy that emphasises massed-practise of language, where communication is framed through language action games that approximate everyday interactions. Despite increasing interest in ILAT, a comprehensive description of its methods has thus far been missing. Furthermore due to inconsistent results, further exploration of cortical reorganisation of language functions following ILAT is warranted. The underlying principles and practical features of ILAT methods and of language-action games are fully described, including the structure and materials for two specific games. 14 English speaking patients with chronic aphasia underwent two weeks of ILAT utilising the methods outlined. Pre and post measures of language performance were collected through standardised clinical assessments, along with functional Magnetic Resonance Imaging scans from a subset of 8 patients. Accuracy and response times for speech output and comprehension during language-action games were also recorded to measure success during the therapy interval. Data analysis showed significant improvements in clinical assessments of naming and comprehension, but not in auditory or syntactic processing tasks. Significant increases were also seen in patients’ self-ratings of quality of communication following therapy. Video and voice recordings during therapy sessions demonstrated significantly faster response times in production and comprehension of language, alongside an increase in the complexity of patients’ spoken output. Cortical activation was recorded whilst patients heard low-level noise, sentences containing ambiguous words and low-ambiguity sentences. Although the results showed no changes in cortical activation in the group of patients whilst processing low-level noise or low ambiguity sentences, increases in language-induced activation were seen in single-subject analyses in both the left and right hemispheres. Furthermore the group of patients recruited the right hemisphere significantly more than the left hemisphere following ILAT when processing complex sentences containing ambiguous words. iii Clinical assessments and measures of everyday communication showed undergoing two weeks of ILAT significantly improved speech output and comprehension in patients with chronic aphasia. Gains made in communicative performance during therapy highlight the importance of recording therapy sessions for additional assessment of therapy efficacy. Although conclusions regarding cortical reorganisation are not entirely clear, they indicate the important role of the right hemisphere in reorganisation of language after stroke.

As a result of rapid development in Emergency Medicine and Intensive Care the patients with brain damage have better chances of surviving than they had in the past. However the survivors need to deal with severe loss of function and consequences resulting from that. An excellent primary care for patients who suffer from strok is provided in Czech Republic, the rehabilitation on the other hand is insufficient. The main problem is an absence of continuity of care which leads to aneffective outcomes and increase of total costs of treatment The purpose of this diploma theses was to evaluate the possibilities of occupational therapist of interprofessional collaboration in community based rehabilitation - in client's home environment. There are several categories of brain damage including acquired brain injury, genetic brain disorders and brain damage acquired during labor. The goal was to detect basic deficient fields. Results of this thesis based on knowledge from foreign literature as well as own experiencis in the team. Results might be used as basis for designed guidelines to improve situation. One client with degenerative brain disorder and five with acquired brain injury which live in home environment were selected. Three months long therapy was provided to them, occupational therapist as case...

Anodal transcranial direct current stimulation (tDCS) is an intervention which is thought to enhance motor learning in healthy and stroke-injured states, when applied adjunctively during skill learning. We set out to investigate whether anodal tDCS might enhance functional rehabilitation from incomplete tetraplegic SCI. To address current limitations in the measurement of task-dependent skill, a novel integrated skill training and measurement task, the Motor Skill Rehabilitation Task (MSRT) was designed and developed. Measures of performance from this task delivered the functional measure of spatial motor skill learning, Task Productivity Rate (TPR). TPR was analysed and validated as a univariate dependent outcome, which is of potential importance to the future development of clinical measures measuring goal-directed motor skills. The MSRT was included alongside conventional behavioural measures in a repeated-measures RCT pilot study, the first to investigate the effect of anodal tDCS on rehabilitation of motor skill from chronic spinal cord injury. Adjunctive application of anodal tDCS had a statistically significant benefit upon retention of skill in the incomplete spinal cord injured population, but only when the independent factor of sensory acuity was included in the analysis. Differences between the development of task-dependent skill and generic dexterity over time suggested that spatial skill development was subject to an interaction of short-term and lasting effects. A larger study in healthy persons further investigated these phenomena, also applying Transcranial Magnetic Stimulation (TMS)–evoked measurements to investigate intervention-dependent effects upon the excitability of projections between the primary motor cortex and muscles involved in the prehension task. The findings revealed that active tDCS did not enhance skill learning at 7 days beyond the training period, but did significantly alter the development of motor skill following a period of learning and subsequent skill consolidation which was associated with underlying perturbation of motor control strategy. Significant and divergent patterns of cortical plasticity were evoked in projections to muscles necessary for reaching and grasping. The main findings of this thesis do not support anodal tDCS as an effective adjunctive means of enhancing spatial motor skill in rehabilitation from incomplete tetraplegic SCI. If applied in patient populations, the clinical benefits of anodal tDCS may be contingent both on the nature of the sensorimotor deficit affecting upper limb function and the spatial demands of the behavioural task. The findings of this project serve to inform further research in relation to the effect of anodal tDCS on the brain and behavioural outcomes, the potential for efficacy in target patient groups and the sensitivity of outcome measures to spatial and temporal dimensions of practical motor skills.

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.

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

This thesis considers the provision of person-centred care (PCC) in acute healthcare. In recent years it has been increasingly recognised that healthcare should be delivered in a person-centred manner and that staff should receive training and support in relation to this. There is a growing body of literature investigating the potential benefits of PCC in relation to both patient and service level outcomes. Paper one of this thesis is a systematic review of the literature examining staff training interventions for improving PCC in acute healthcare settings. The findings offer preliminary support for the positive impact of such training interventions on patient and service level outcomes in hospital environments. The research in this area is not of a uniformly high standard and this paper concludes that further research in this area is required. Paper two is an examination of a modified version of Dementia Care Mapping (Care Mapping – Neurorehabilitation: DCM-NR), an observational tool for measuring and improving PCC. Results provide evidence of the feasibility and validity of DCM-NR in a range of Clinical Neuroscience settings. Future research should examine the impact of DCM-NR on person-centred practices over time.The critical reflection paper considers both the systematic review and the empirical study. It aims to consider both the strengths and limitations of the research, challenges encountered, clinical implications and highlights areas for future research.

Background. Paper I: Published guidelines and policies continually promote the importance of increasing service-user involvement in health care services. Q-methodology has become a popular method for revealing the subjective perspectives of patients who use health services, yet there is currently no review considering the potential issues of using Q-methodology with clinical populations. Paper II: Measuring the quality of care for people using neurorehabilitation services is a complex area requiring reliable methods. Dementia Care Mapping (DCM) is used widely in dementia care settings to help improve person-centred care and with appropriate evaluation may be usefully applied to neurorehabilitation settings. Aims. Paper I [literature review] examined studies which used Q-methodology with clinical populations, with a particular emphasis on the potential adaptations required to ensure its reliable use. Paper II [research study] explored the acceptability views of staff and patients for the pilot use of DCM in a neurorehabilitation setting. Paper III attempted to critically appraise these papers, as well as the research process overall. Methods. Paper I reviewed 29 studies, published over a 20-year period, using a narrative synthesis. Paper II conducted DCM on an acute neurorehabilitation ward, and evaluated the acceptability of DCM using Q-methodology with 23 staff and 10 patients on the ward. Results. Paper I identified a number of considerations for the effective application of Q-methodology with clinical populations. Paper II, reporting on the factor analysis, indicated a 'consensus' viewpoint, where all participants indicated positive acceptability for the use of DCM in a neurorehabilitation setting, with additional factors indicating some potential changes to the tool for increasing acceptability in the future. Paper II also indicated the potential for Q-methodology to be useful with a neurorehabilitation in-patient population. Conclusion. Paper I indicated the potential worth of Q-methodology for use with clinical populations. It also indicated guidelines which researchers might consider when using this method with clinical populations in the future. Paper II revealed promising results for the acceptability of DCM in a neurorehabilitation setting, though further research is required to explore this further. It also confirmed the value of Q-methodology with patients within a neurorehabilitation setting, similarly to those in Paper I. Paper III explored the relevance of Papers I and II in adding to the literature independently, but also the unequivocal link regarding the use of Q-methodology with clinical populations.

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We evaluated the effectiveness of two virtual reality therapies (VRT) with visual biofeedback, Armeo Spring® upper limb exoskeleton (Armeo) and Homebalance® interactive system (Homebalance), in early post-stroke rehabilitation. Using a randomized controlled study design, participants within 30 days after stroke with arm paresis (Armeo study) or with balance problem (Homebalance study) were assigned either to the respective intervention group (Armeo IG n=25; mean age 66.5 years, and Homebalance IG n=25; mean age 69.6 years) performing VRT instead of conventional physiotherapy or to the control group (Armeo CG, n=25, mean age 68.1 years, and Homebalance CG, n=25, mean age 65.9 years) having conventional physiotherapy only. Montreal Cognitive Assessment (MoCA), Functional Independence Measure (FIM), Fugl Mayer Assessment-Upper Extremity Scale (FMA-UE), Modified Rivermead Mobility Index (m-RIM) and Berg Balance Scale (BBS) were performed before and after the 3-week therapy with 12 therapies. Results of participants <65 and ≥65 years old were compared. Acceptance of both VRTs was evaluated by self-rated questionnaire. In the Armeo study, paretic upper arm function improved significantly in both IG and CG groups, the improvement in FMA-UE was significantly higher in Armeo IG as compared to CG (p=0.02)...