Austrian innovators believe they may have cracked one of the great global challenges of post-stroke rehab. One-to-one therapy can be hugely effective in enabling patients to regain lost functions. 

Yet personnel and resource shortages often mean the individual’s time in this setting is limited. Technology company Rewellio has developed a potential solution, combining EMG biofeedback and an app to help patients recover lost hand movement after stroke. 

Its aim is to enable more therapy time and promote a faster, motivating and independent recovery process.

Founder and CEO Georg Teufl says: “Our initial idea was to work out how we could enable a stroke patient more therapy time. Hand rehabilitation is particularly tricky, especially in the early stages when quite often the muscle contractions are so weak that no visible movements can be seen. Therefore, the patient at home has no real feedback as to whether or not the exercises are being done correctly.”

Rewellio’s app is used with a compatible EMGbiofeedback device which can detect any minimal muscle activity in the affected limb.

Often these movements are too weak to move the hand, but provide a platform on which the patient can build.

The data is transmitted to the app and incorporated into the rehab session, giving patients instant feedback during their exercises.

This allows for a fully functional, virtual hand that shows users the real-time activity of their targeted muscles.

Teufl says: “The aim of this concept is to ‘trick’ the brain so that it relearns which signals produce the right outcome in movement. The repetition of these exercises helps the patient get back some functional use of the hand, which becomes the basis for other exercises, such as training for more precise movements of the hand and fingers.”

The system is designed to both assist therapists in clinical and rehabilitation settings, and to give the patient extra independent therapy time at home. It supports dozens of exercises for arm and hand rehab – encouraged through a series of interactive games. These are played via the app on a tablet or a virtual reality headset, with EMG biofeedback bracelets providing the real-time data.

As well as boosting exercise hours after stroke, Rewellio’s approach to rehab is also driven by the power of motor imagery; the mental practice of movement without physical movement.

Motor imagery, and also observation of actions, are shown in various studies to improve motor performance and upper limb function after a stroke. They are also commonly used to improve performance in elite-level sport.

Imagining and observing activates certain motor-related regions, such as the premotor cortex and inferior parietal lobule – the same areas in the brain used in the actual movement (Mizuguchi et al, 2017). Both motor imagery and action observation are connected to the mirror neuron system, defined as the network for understanding actions performed by others.

These neurons discharge either when the individual is performing a motor task or watching someone else perform a related action. Action observation and motor imagery use this mechanism for the recovery of motor impairment.

A number of studies describe the findings and knowledge of the mirror neuron system as a source of information to motor training after stroke (Garrison et al, 2010).

Research also shows that there is no difference in a healthy person’s functional magnetic resonance imaging (fMRI) when watching real or virtual hands. These findings bring virtual reality (VR) to the next level as a promising tool for neuro-rehab (Brihmat et al, 2018).

Teufl says: “Immersive VR in combination with hand tracking capabilities allows for very efficient therapy methods.”

This, he says, can be used to build on the traditional mirror therapy concept – in which a mirror is placed in the person’s midsagittal plane, thus reflecting movements of the nonparetic side as if it were the affected side.

“The sensors in the VR headset make it possible to capture the patient’s improvement precisely helping the therapist to recommend the best possible therapy modules at any given stage.”

Teufl founded Rewellio in 2017, bringing together his experiences as a stroke therapist and his “passion” for software development. The company is headquartered in Austria, with a US office in Los Angeles and plans underway to establish a presence in Australia.

It recently raised  €800,000 in angel investment, part of which will fund clinical trials into the technology.

“There are so many research questions we have opened up with this technology. We want to work with as many research institutions as possible to increase the amount of evidence for what we are doing. We’re currently preparing for the trial and [enlisting] pilot customers.

“We’re keen to connect with pilot customers who want to try out the technology and get an understanding of how they can benefit from it.”

Professionals and patients interested in trialling the technology are encouraged to visit www.rewellio.com or email info@ rewellio.com.