Background: Few research in multiple sclerosis (MS) has focused on physical rehabilitation of upper limb dysfunction, though the latter strongly influences independent performance of activities of daily living. Upper limb rehabilitation technology could hold promise for complementing traditional MS therapy. Consequently, this pilot study aimed to examine the feasibility of an 8-week mechanical-assisted training program for improving upper limb muscle strength and functional capacity in MS patients with evident paresis. Methods: A case series was applied, with provision of a training program (3×/week, 30 minutes/session), supplementary on the customary maintaining care, by employing a gravity-supporting exoskeleton apparatus (Armeo Spring). Ten high-level disability MS patients (Expanded Disability Status Scale 7.0-8.5) actively performed task-oriented movements in a virtual real-life-like learning environment with the affected upper limb. Tests were administered before and after training, and at 2-month follow-up. Muscle strength was determined through the Motricity Index and Jamar hand-held dynamometer. Functional capacity was assessed using the TEMPA, Action Research Arm Test (ARAT) and 9-Hole Peg Test (9HPT). Results: Muscle strength did not change significantly. Significant gains were particularly found in functional capacity tests. After training completion, TEMPA scores improved (p = 0.02), while a trend towards significance was found for the 9HPT (p = 0.05). At follow-up, the TEMPA as well as ARAT showed greater improvement relative to baseline than after the 8-week intervention period (p = 0.01, p = 0.02 respectively). Conclusions:The results of present pilot study suggest that upper limb functionality of high-level disability MS patients can be positively influenced by means of a technology-enhanced physical rehabilitation program.

BackgroundClient-centred task-oriented training is important in neurological rehabilitation but is time consuming and costly in clinical practice. The use of technology, especially motion capture systems (MCS) which are low cost and easy to apply in clinical practice, may be used to support this kind of training, but knowledge and evidence of their use for training is scarce. The present review aims to investigate 1) which motion capture systems are used as training devices in neurological rehabilitation, 2) how they are applied, 3) in which target population, 4) what the content of the training and 5) efficacy of training with MCS is.MethodsA computerised systematic literature review was conducted in four databases (PubMed, Cinahl, Cochrane Database and IEEE). The following MeSH terms and key words were used: Motion, Movement, Detection, Capture, Kinect, Rehabilitation, Nervous System Diseases, Multiple Sclerosis, Stroke, Spinal Cord, Parkinson Disease, Cerebral Palsy and Traumatic Brain Injury. The Van Tulder’s Quality assessment was used to score the methodological quality of the selected studies. The descriptive analysis is reported by MCS, target population, training parameters and training efficacy.ResultsEighteen studies were selected (mean Van Tulder score = 8.06 ± 3.67). Based on methodological quality, six studies were selected for analysis of training efficacy. Most commonly used MCS was Microsoft Kinect, training was mostly conducted in upper limb stroke rehabilitation. Training programs varied in intensity, frequency and content. None of the studies reported an individualised training program based on client-centred approach.ConclusionMotion capture systems are training devices with potential in neurological rehabilitation to increase the motivation during training and may assist improvement on one or more International Classification of Functioning, Disability and Health (ICF) levels. Although client-centred task-oriented training is important in neurological rehabilitation, the client-centred approach was not included. Future technological developments should take up the challenge to combine MCS with the principles of a client-centred task-oriented approach and prove efficacy using randomised controlled trials with long-term follow-up.Trial registrationProspero registration number 42016035582.Electronic supplementary materialThe online version of this article (doi:10.1186/s12984-017-0270-x) contains supplementary material, which is available to authorized users.

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Background Maintaining or initiating regular physical activity (PA) is important for successful aging. Technology-based systems may support and stimulate older adults to initiate and persevere in performing PA. The aim of the current study was to assess to which extent a customised Kinect system is 1) a credible tool to increase PA in older adults, 2) motivating to perform PA by older adults, and 3) easy to be used in older adults. Methods A mixed-method cross-sectional feasibility study was performed in 5 aged care facilities in Flanders, Belgium. Aged participants were asked to perform a 20–30 min test with the intelligent Activity-based Client-centred Training (i-ACT) system. After the test, the ‘Credibility and Expectancy Questionnaire’ (CEQ), the ‘Intrinsic Motivation Inventory’(IMI), the System Usability Scale (SUS), and semi-structured interviews were conducted in the older adults. Feedback was gathered using the thinking aloud method in both aged participants and healthcare professionals. Results A total of 48 older adults (20 males and 28 females, mean age = 81.19 (SD = 8.10)), were included. The scores pertaining to system credibility and expectancy, system usability, and motivation towards use were moderate to good. Participants reported that they liked using the i-ACT system, but that the context could be more attractive by adding more visualisations. Twelve professionals stated that they observed involvement in older adults but think that i-ACT is better used in day care centres. Conclusions This study indicates that i-ACT is a usable and motivational system to engage older adults to perform PA and therefore supports successful aging. Future research is necessary to investigate the efficacy of i-ACT to perform PA and the transfer to regain and/or maintain engagement in ADLs that older adults find meaningful and purposeful at an older age. Also, further development of i-ACT is advisable to adapt the i-ACT system towards implementation at the home of older adults. Trial registration ClinicalTrial.gov ID NCT04489563, 23 July 2020 - Retrospectively registered.

(1) Background: technology-based training systems are increasingly integrated in neurorehabilitation but are rarely combined with a client-centred task-oriented approach. To provide a low-cost client-centred task-oriented system, the intelligent activity-based client-centred task-oriented training (i-ACT) was developed. The objective was to evaluate the usability, credibility and treatment expectancy of i-ACT, and the motivation towards i-ACT use in rehabilitation over time. Additionally, this study will evaluate the upper limb treatment effects after training with i-ACT. (2) Methods: a mixed-method study was performed in four rehabilitation centres. Training with i-ACT was provided during six weeks, three times per week, forty-five minutes per day, additional to conventional care. (3) Results: seventeen persons with central nervous system diseases were included. High scores were seen in the system usability scale (score ≥ 73.8/100), credibility (score ≥ 22.0/27.0)/expectancy (score ≥ 15.8/27.0) questionnaire, and intrinsic motivation inventory (score ≥ 5.2/7.0), except the subscale pressure (score ≤ 2.0/7.0). Results from the interviews corroborate these findings and showed that clients and therapists believe in the i-ACT system as an additional training support system. Upper limb functional ability improved significantly (p < 0.05) over time on the Wolf motor function test. (4) Conclusion: i-ACT is a client-centred task-oriented usable and motivational system which has the potential to enhance upper limb functional training in persons with neurological diseases.

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BackgroundMaintaining or initiating regular physical activity (PA) is important for successful aging. Technology-based systems may support and stimulate aged persons to initiate and persevere in performing PA. The aim of the current study was to assess to which extent a customised Kinect system is 1) a credible tool to increase PA in aged persons, 2) motivating to perform PA by aged persons, and 3) easy to be used in aged persons. MethodsA mixed-method cross-sectional feasibility study was performed in 5 aged care facilities in Flanders, Belgium. Aged participants were asked to perform a 20-30 minute test with the intelligent Activity-based Client-centred Training (i-ACT) system. After the test, the ‘Credibility and Expectancy Questionnaire’ (CEQ), the ‘Intrinsic Motivation Inventory’(IMI), the System Usability Scale (SUS), and semi-structured interviews were conducted in the aged participants. Feedback was gathered using the thinking aloud method in both aged participants and supervisors. ResultsA total of 48 aged persons (20 males and 28 females, mean age=81.19 (SD=8.10)), were included. The scores pertaining to system credibility and expectancy, system usability, and motivation towards use were moderate to good. Participants reported that they liked using the i-ACT system, but that the context could be more attractive by adding more visualisations. Twelve supervisors gave feedback regarding the i-ACT systems itself, the use and motivational aspects. ConclusionsThis study indicates that i-ACT is a useful and motivational system to engage aged persons to perform PA and therefore supports successful aging. Furthermore, i-ACT is a low-cost, easy to use and controller/wire-free system, which makes i-ACT a suitable tool for use in the home environment. Further development and future research is necessary to adapt the i-ACT system towards the wishes and needs of the aged population at home and in care facilities. Future research should include the effect of using a client-centred task-oriented approach in combination with technology-supported systems to engage aged persons to perform PA. Trial registrationClinicalTrial.gov ID NCT04489563, 23 July 2020 - Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000A39C&selectaction=Edit&uid=U0003E6F&ts=37&cx=2jhfvs