J H Crosbie

University of Ulster, Aontroim, N Ireland, United Kingdom

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Publications (18)16.62 Total impact

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    ABSTRACT: Purpose ‐ Computer-based systems for motor function rehabilitation have been around for more than a decade, with work done to help recovery of function in the lower limb (ankle, leg) as well as upper limb (hand and arm). Design/methodology/approach ‐ More recently there has been a trend towards the use of game-based systems to deliver rehabilitation goals. The authors' interdisciplinary group has been working in the area of motor function recovery of the hand and arm (following stroke) for a number of years, using both high-end virtual reality (VR) technology as well as low-cost video capture technology. Findings ‐ Over this time it has become clear that there are many challenges in designing usable, effective game-based systems for motor function rehabilitation. Originality/value ‐ This paper reflects on user experiences across the range of technologies developed by the group. It presents a summary review of the authors' systems and details the protocols and user evaluation instruments used. It then critically reflects on this work and reviews other recent advances in game usability and playability, leading to suggestions for how the user experience of games for rehabilitation may be improved in future work.
    Journal of Assistive Technologies. 09/2012; 6(3).
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    ABSTRACT: To assess the feasibility of a trial to investigate the effectiveness of virtual reality-mediated therapy compared to conventional physiotherapy in the motor rehabilitation of the arm following stroke, and to provide data for a power analysis to determine numbers for a future main trial. Pilot randomized controlled trial. Clinical research facility. Eighteen people with a first stroke, 10 males and 8 females, 7 right and 2 left side most affected. Mean time since stroke 10.8 months. Participants were randomized to a virtual reality group or a conventional arm therapy group for nine sessions over three weeks. The upper limb Motricity Index and the Action Research Arm Test were completed at baseline, post intervention and six weeks follow-up. Outcome data were obtained from 95% of participants at the end of treatment and at follow-up: one participant withdrew. Compliance was high; only two people reported side-effects from virtual reality exposure. Both groups demonstrated small (7-8 points on upper limb Motricity Index and 4 points on the Action Research Arm Test), but non-significant, changes to their arm impairment and activity levels. A randomized controlled trial of virtual reality-mediated therapy comparable to conventional therapy would be feasible, with some suggested improvements in recruitment and outcome measures. Seventy-eight participants (39 per group) would be required for a main trial.
    Clinical Rehabilitation 01/2012; 26(9):798-806. · 2.18 Impact Factor
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    ABSTRACT: There is now sufficient evidence that using a rehabilitation protocol involving motor imagery (MI) practice in conjunction with physical practice (PP) of goal-directed rehabilitation tasks leads to enhanced functional recovery of paralyzed limbs among stroke sufferers. It is however difficult to confirm patient engagement during an MI in the absence of any on-line measure. Fortunately an EEG-based brain-computer interface (BCI) can provide an on-line measure of MI activity as a neurofeedback for the BCI user to help him/her focus better on the MI task. However initial performance of novice BCI users may be quite moderate and may cause frustration. This paper reports a pilot study in which a BCI system is used to provide a computer game-based neurofeedback to stroke participants during the MI part of a protocol. The participants included five chronic hemiplegic stroke sufferers. Participants received up to twelve 30-minute MI practice sessions (in conjunction with PP sessions of the same duration) on 2 days a week for 6 weeks. The BCI neurofeedback performance was evaluated based on the MI task classification accuracy (CA) rate. A set of outcome measures including action research arm test (ARAT) and grip strength (GS), was made use of in assessing the upper limb functional recovery. In addition, since stroke sufferers often experience physical tiredness, which may influence the protocol effectiveness, their fatigue and mood levels were assessed regularly. Positive improvement in at least one of the outcome measures was observed in all the participants, while improvements approached a minimal clinically important difference (MCID) for the ARAT. The on-line CA of MI induced sensorimotor rhythm (SMR) modulation patterns in the form of lateralized event-related desynchronization (ERD) and event-related synchronization (ERS) effects, for novice participants was in a moderate range of 60-75% within the limited 12 training sessions. The ERD/ERS change from the first to the last session was statistically significant for only two participants. Overall the crucial observation is that the moderate BCI classification performance did not impede the positive rehabilitation trends as quantified with the rehabilitation outcome measures adopted in this study. Therefore it can be concluded that the BCI supported MI is a feasible intervention as part of a post-stroke rehabilitation protocol combining both PP and MI practice of rehabilitation tasks. Although these findings are promising, the scope of the final conclusions is limited by the small sample size and the lack of a control group.
    Journal of NeuroEngineering and Rehabilitation 01/2010; 7:60. · 2.62 Impact Factor
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    ABSTRACT: Effective stroke rehabilitation must be early, intensive and repetitive, which can lead to problems with patient motivation and engagement. The design of video games, often associated with good user engagement, may offer insights into how more effective systems for stroke rehabilitation can be developed. In this paper we identify game design principles for upper limb stroke rehabilitation and present several games developed using these principles. The games use low-cost video-capture technology which may make them suitable for deployment at home. Results from evaluating the games with both healthy subjects and people with stroke in their home are encouraging.
    The Visual Computer 12/2009; 25(12):1085-1099. · 1.07 Impact Factor
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    ABSTRACT: Objectives: The aim of this research team has been to develop and test a range of virtual technologies for their feasibility and effectiveness in upper limb stroke rehabilitation. The principles of neural plasticity, motor control and skill training have informed the design and development of our systems and practice tasks. The purpose of this paper is to present a summary of our work to date and discuss what we have learned throughout the development, testing and implementation of this type of intervention in people with stroke. Methods: Virtual technologies are being used to provide people who have stroke with opportunities to practice in a more focused way, and to offer support to continue having access to therapy for more extended periods of time. The systems reported on in this paper are at various stages of development and user testing. Methods employed during the course of our investigations have been both qualitative and quantitative, including questionnaires, participant interviews, single case series and a randomized controlled trial design. Results: Our work has focused mainly on incorporating the principles of motor learning which seem to be most effective in promoting motor recovery following stroke, i.e. repetitive, functional and task related practice of active movement of the limbs. A number of other research groups have prioritised game style activities which concentrate on the motivation to practice. Results from a series of studies, with both non disabled and stroke users, indicate that the use of virtual technologies to augment and support rehabilitation after stroke is feasible and has positive effects on motor impairment and activity levels. Discussion/conclusion: This paper has presented an overview of the work our research team has been engaged in since 2003. There have been developments in two key areas, moving from unilateral practice to bilateral practice and incorporating these movements into game based systems. We plan to continue to test our systems against current standard care with a long-term aim to empower stroke users in their own rehabilitation.
    Physical Therapy Reviews 09/2009; 14(5):336-347.
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    ABSTRACT: There is now sufficient evidence that using a rehabilitation protocol involving motor imagery (MI) practice (or mental practice (MP)) in conjunction with physical practice (PP) of goal-directed rehabilitation tasks leads to enhanced functional recovery of paralyzed limbs among stroke sufferers. It is however difficult to ensure patient engagement during MP in the absence of any on-line measure of the MP. Fortunately in an EEG-based brain-computer interface (BCI), an on-line measure of MI activity is used to devise neurofeedback for the BCI user to help him/her focus better on the task. This paper reports a pilot study in which an EEG-based BCI system is used to provide neurofeedback to stroke participants during the MP part of the rehabilitation protocol. This helps patients to undertake the MP with stronger focus. The participants included five chronic stroke sufferers. The trial was undertaken for 12 sessions over a period of 6 weeks. A set of rehabilitation outcome measures including action research arm test (ARAT) and motricity index was made use of in assessing functional recovery. Moderate improvements approaching a minimal clinically important difference (MCID) were observed for the ARAT. Small positive improvements were also observed in other outcome measures. Participants appeared highly enthusiastic about participating in the study and regularly attended all the sessions. Although without a randomized control trial, it is difficult to ascertain whether the enhanced rehabilitation gain is primarily because of BCI neurofeedack, the positive gains in outcome measures demonstrate the potential and feasibility of using BCI for post-stroke rehabilitation.
    Neural Engineering, 2009. NER '09. 4th International IEEE/EMBS Conference on; 06/2009
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    ABSTRACT: Stroke is a leading cause of severe physical disability, causing a range of impairments. Frequently stroke survivors are left with partial paralysis on one side of the body and movement can be severely restricted in the affected sidepsilas hand and arm. We know that effective rehabilitation must be early, intensive and repetitive, which leads to the challenge of how to maintain motivation for people undergoing therapy. This paper discusses why games may be an effective way of addressing the problem of engagement in therapy and analyses which game design patterns may be important for rehabilitation. We present a number of serious games that our group has developed for upper limb rehabilitation. Results of an evaluation of the games are presented which indicate that they may be appropriate for people with stroke.
    Games and Virtual Worlds for Serious Applications, 2009. VS-GAMES '09. Conference in; 04/2009
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    ABSTRACT: To assess the utility of virtual reality (VR) in stroke rehabilitation. The Medline, Proquest, AMED, CINAHL, EMBASE and PsychInfo databases were electronically searched from inception/1980 to February 2005, using the keywords: Virtual reality, rehabilitation, stroke, physiotherapy/physical therapy and hemiplegia. Articles that met the study's inclusion criteria were required to: (i) be published in an English language peer reviewed journal, (ii) involve the use of VR in a stroke rehabilitation setting; and (iii) report impairment and/or activity oriented outcome measures. Two assessors independently assessed each study's quality using the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) grading system. Eleven papers met the inclusion criteria: Five addressed upper limb rehabilitation, three gait and balance, two cognitive interventions, and one both upper and lower limb rehabilitation. Three were judged to be AACPDM Level I/Weak, two Level III/Weak, three Level IV/Weak and three Level V quality of evidence. All articles involved before and after interventions; three randomized controlled trials obtained statistical significance, the remaining eight studies found VR-based therapy to be beneficial. None of the studies reported any significant adverse effects. VR is a potentially exciting and safe tool for stroke rehabilitation but its evidence base is too limited by design and power issues to permit a definitive assessment of its value. Thus, while the findings of this review are generally positive, the level of evidence is still weak to moderate, in terms of research quality. Further study in the form of rigorous controlled studies is warranted.
    Disability and Rehabilitation 08/2007; 29(14):1139-46; discussion 1147-52. · 1.84 Impact Factor
  • Disability and Rehabilitation 01/2007; 29(14):1151-1152. · 1.84 Impact Factor
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    ABSTRACT: Our group has developed a relatively low-cost virtual reality (VR) system for rehabilitation of the upper limb following stroke. Our system is immersive in that the participant views a representation of their arm and hand, reaching and retrieving objects in the virtual environment (VE), through a head-mounted display (HMD). This is thought to increase the participant's sense of presence in the VE and may lead to improved rehabilitation outcomes. However, use of immersion, particularly with our low-cost system, may increase the incidence of side effects reported. Therefore, the aim of this project was to assess the interaction of healthy users and those following stroke, in terms of their experience of presence in the VE and the rate of self-reported side effects. Differences in rates of perceived exertion, levels of enjoyment, and sense of control between both groups were also explored.
    CyberPsychology & Behavior 05/2006; 9(2):137-41. · 2.71 Impact Factor
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    ABSTRACT: Virtual reality (VR) provides a three-dimensional computer representation of a real world or imaginary space through which a person can navigate and interact with objects to carry out specific tasks. VR can be used as an assessment and training tool for patients with stroke who have sensory-motor deficits of the limbs. Our research group has built a system, which gives the user the ability to interact with objects by touching, grasping and moving their upper limb. A range of user perspectives has been tested with people following stroke and the relationship between the user experience and their level of impairment has been explored
    Virtual Rehabilitation, 2006 International Workshop on; 01/2006
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    ABSTRACT: Virtual reality (VR) provides a three-dimensional computer representation of a real world or imaginary space through which a person can navigate and interact with objects to carry out specific tasks. One novel application of VR technology is in rehabilitation following stroke, particularly of the upper limb. This paper describes the development of a VR system for use in this field. This system gives the user the ability to interact with objects by touching, grasping and moving their upper limb.
    Studies in health technology and informatics 02/2005; 117:218-22.
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    ABSTRACT: Approximately 80% of people who sustain a stroke survive and although most people regain their ability to walk, 30 - 66% of survivors are no longer able to use the affected arm. Early intensive practice of active functional tasks in an enriched environment can lead to more positive outcomes for upper limb rehabilitation. One way in which practice intensity and multimodal feedback can be manipulated to retrain movement in the upper limb is through immersive virtual reality (VR) technology. This paper describes an immersive VR system which is both patient and operator-focused. The goals of the research are firstly to ascertain whether VR can improve patient rehabilitation over traditional methods and secondly to evaluate the usability of the system for rehabilitation professionals. Results suggests that patients respond well to the system and that careful design can lead to a VR system capable of everyday use by non-computing professionals.
    Systems, Man and Cybernetics, 2004 IEEE International Conference on; 11/2004
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    ABSTRACT: To assess the feasibility and practicalities of using the technique of mental practice as an adjunct in the rehabilitation of the upper limb following stroke. A series of single-case studies. A stroke rehabilitation unit in Belfast. Fourteen patients admitted for rehabilitation of their first stroke: six men and four women, aged 45-81 between 10 and 176 days post stroke. Each patient underwent a single-case design, with two weeks baseline, two weeks intervention and one week withdrawal. The intervention consisted of structured daily mental practice sessions of a reach and grasp task, in addition to their usual therapy. The upper limb component of the Motricity Index was used to grade motor activity sequentially across the timescale of the study. Of the 14 patients recruited, four withdrew and 10 completed the study. Nine showed improvement in upper limb Motricity Index score with mental practice as measured by the two-band standard deviation method. One of these cases demonstrated an unstable baseline such that changes could not be attributed to intervention. This pilot study suggests that mental practice may be useful as an adjunct to physiotherapy after stroke.
    Clinical Rehabilitation 03/2004; 18(1):60-8. · 2.18 Impact Factor
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    ABSTRACT: Objective: To assess the feasibility and practicalities of using the technique of mental practice as an adjunct in the rehabilitation of the upper limb following stroke.Design: A series of single-case studies.Setting: A stroke rehabilitation unit in Belfast.Subjects: Fourteen patients admitted for rehabilitation of their first stroke: six men and four women, aged 45–81 between 10 and 176 days post stroke.Intervention: Each patient underwent a single-case design, with two weeks baseline, two weeks intervention and one week withdrawal. The intervention consisted of structured daily mental practice sessions of a reach and grasp task, in addition to their usual therapy.Main outcome measures: The upper limb component of the Motricity Index was used to grade motor activity sequentially across the timescale of the study.Results: Of the 14 patients recruited, four withdrew and 10 completed the study. Nine showed improvement in upper limb Motricity Index score with mental practice as measured by the two-band standard deviation method. One of these cases demonstrated an unstable baseline such that changes could not be attributed to intervention.Conclusions: This pilot study suggests that mental practice may be useful as an adjunct to physiotherapy after stroke.
    Clinical Rehabilitation 02/2004; 18(1):60-68. · 2.18 Impact Factor
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    ABSTRACT: The aim of this study was to assess the feasibility of an RCT to investigate VR mediated therapy in comparison to standard physiotherapy alone in the motor rehabilitation of the upper limb following stroke, and to provide data to inform a power analysis to determine numbers for a future trial. A single blinded randomised controlled trial was conducted. Participants were recruited from two hospital stroke units and members of local Northern Ireland Chest, Heart and Stroke Association clubs. The Upper Limb Motricity Index, Action Research Arm Test were completed at baseline, post-intervention and 6 weeks follow-up. 18 participants were randomised to either a VR mediated upper limb therapy group or a standard therapy group. No significant between group differences were noted. Both groups reported some small changes to their upper limb activity levels. Both interventions seemed to have been acceptable to participants. This study demonstrated the feasibility of a randomised controlled trial of virtual reality mediated therapy for the upper limb compared to standard therapy. Forty-eight participants (24 per group) would be needed to complete an adequately powered study.
  • Jacqueline Crosbie, Suzanne McDonough
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    ABSTRACT: Stroke is a leading cause of severe physical disability and can result in of a range of impairments, including loss of balance, attention and concentration deficiencies, pain, weakness and paralysis. This paper reports on the design of serious games for upper limb rehabilitation following stroke. In particular, we focus on identifying principles of video game design which are important in the context of rehabilitation and show how these principles can be implemented. We also report on an evaluation of the games for playability, usability and engagement.