BackgroundRehabilitation technology for upper limb training of stroke patients may play an important role as therapy tool in future, in order to meet the increasing therapy demand. Currently, implementation of this technology in the clinic remains low. This study aimed at identifying criteria and conditions that people, involved in development of such technology, should take into account to achieve a (more) successful implementation of the technology in the clinic.MethodsA literature search was performed in PubMed and IEEE databases, and semi-structured interviews with therapists in stroke rehabilitation were held, to identify criteria and conditions technology should meet to facilitate (implementation of) technology-assisted arm-hand skills training in rehabilitation therapy of stroke patients. In addition, an implementation strategy frequently applied in general health care was used to compose a stepwise guidance to facilitate successful implementation of this technology in therapy of stroke patients. Implementation-related criteria mentioned by therapists during the interviews were integrated in this guidance.ResultsResults indicate that, related to therapy content, technology should facilitate repetition of task-related movements, tailored to the patient and patient’s goals, in a meaningful context. Variability and increasing levels of difficulty in exercises should be on offer. Regarding hardware and software design of technology, the system should facilitate quick familiarisation and be easily adjustable to individual patients during therapy by therapists (and assistants). The system should facilitate adaptation to individual patients’ needs and their progression over time, should be adjustable as to various task-related variables, should be able to provide instructions and feedback, and should be able to document patient’s progression. The implementation process of technology in the clinic is provided as a stepwise guidance that consists of five phases therapists have to go through. The guidance includes criteria and conditions that motivate therapists, and make it possible for them, to actually use technology in their daily clinical practice.ConclusionsThe reported requirements are important as guidance for people involved in the development of rehabilitation technology for arm-hand therapy of stroke patients. The stepwise guide provides a tool for facilitating successful implementation of technology in clinical practice, thus meeting future therapy demand.

Fear of pain changes movement: Movements associated with pain are performed faster, with more force and higher accuracy than movements that are not associated with pain. These changes can inform us how fear of pain translates into avoidance and escape behaviour, two important constructs in the maintenance of chronic pain.

Musculoskeletal complaints are highly prevalent in clarinetists and are related to high arm load while playing. It is hypothesized that postural exercise therapy may be used to adapt muscle activity patterns while playing and thus contribute to better sound quality. The goal of the present study was to investigate the relationship between body posture, muscle activity, and sound quality in clarinetists while playing the instrument in two different postures, their habitual sitting posture (control, CO) vs an experimental sitting posture (EXP) based on Mensendieck postural exercise therapy, method Samama. Twenty healthy professional and student clarinet players, aged 18-60 years, were included in this cross-sectional study. Participants played a 60-second musical excerpt in CO, followed by instruction on the EXP body posture, and then played in the EXP condition. Two-dimensional goniometric analysis was used to calculate body posture; muscle activity was measured bilaterally using surface electromyography. In EXP, a significantly smaller low thoracic angle, smaller high thoracic angle, and larger pelvic tilt angle (all p<0.001) were found. EMG results indicated that the left and right erector spinae L3 and left and right lower trapezius were more active in EXP compared to CO, whereas left upper trapezius and right brachioradialis were less active in EXP than CO. Most participants experienced better sound quality in EXP, whereas blinded experts found no consistent pattern between body posture and sound quality. To conclude, it seems that postural exercise therapy may change muscle activity patterns. By increasing stability, a decrease in activity of the upper extremity muscles can be induced.