[ARTICLE] Agent-based systems for telerehabilitation: strengths, limitations and future challenges (PDF Download Available) – Full Text

Abstract
Telerehabilitation in older adults is most needed in the patient environments, rather than in formal ambulatories or hospitals. Supporting such practices brings significant advantages to patients, their family, formal and informal caregivers, clinicians, and researchers. Several techniques and technologies have been developed aiming at facilitating and enhancing the effectiveness of telerehabilitation. This paper gives a quick overview of the state of the art, investigating video-based, wear-able, robotic, distributed, and gamified telerehabilitation solutions. In particular, agent-based solutions are analyzed and discussed addressing strength, limitations, and future challenges. Elaborating on functional requirements expressed by professional physiotherapists and researchers, the need for extending multi-agent systems (MAS) peculiarities at the sensing level in wearable solutions establishes new research challenges. Employed in cyber-physical scenarios with users-sensors and sensors-sensors interactions, MAS are requested to handle timing constraints, scarcity of resources and new communication means, which are crucial for providing real-time feedback and coaching.
1 Introduction
Healthcare institutions are facing the strain of a significantly larger elderly population [1]. Lengthening life expectancy is met by an increasing demand for medical and technological contributions to extend the ”good-health”, and disability free period.
The major factor catalyzing the elderly’s impairing process is the progres-
sive reduction of mobility, due to the natural aging process, inactivity, dis-
eases such as osteoarthritis, stroke or other neurological conditions, falls with its consequences, such as fear of falls (leading to inactivity), or fractures (needing surgery).Despite the emergence of less-invasive surgical techniques, post-intervention rehabilitation still requires extended periods and tailored therapies, which usually involve complications. Performing traditional rehabilitative practices is leading to a significant increase in public-health costs and, in some cases a lack of resources, thus worsening the services’ quality. Rehabilitation is often a long process and needs to be sustained long after the end of the acute care. Simplifying the access to health services [2] can raise the number of patients, maintaining (or even increasing) the quality of care. For example, patients requiring support, such as continuous or selective monitoring, can benefit from systems that automatically transmit the information gathered in their domestic environment to the health clinics, thus enabling telemonitoring on their health conditions [3].
Although in traditional solutions telemonitoring is a self-contained practice
limited to passively observing the patients, the need for remote sensing is crucially coupled with the need for coaching older adults in their daily living [4,5].
For example, a critical activity such as telerehabilitation cannot be limited
to observing the patients’ behaviors. Indeed, patient adherence and acceptability of rehabilitative practices need to be actively enhanced, overcoming pitfalls due to motor (e.g., endurance), non-motor (e.g., fatigue, pain, dysautonomic symptoms, and motivational), and cognitive deficits. According to Rodriguez et al. [6], telerehabilitation can be formally defined as:
“the application of telecommunication, remote sensing and operation tech-
nologies, and computing technologies to assist with the provision of med-
ical rehabilitation services at a distance.”
Patients, physiotherapists, and health institutes can gain several benefits
from an extensive adoption of telerehabilitation systems [7]. Considering the
economical point of view, Mozaffarian et al. [8] figured out that the total cost
of stroke in the US was estimable to be 34.3 billion dollars in 2008, rising up to 69.1 billion dollars in 2016.
Even though to date they are not precisely quantifiable due to insufficient evidence [9], Mutingi et al. [10] presented as “inevitable advantages”
(i) a substantial cost saving primarily due to the reduction of specialized human resources,
(ii) an enhancement of patient comfort and lifestyle, and (iii) improvements of therapy and decision making processes. Moreover, Morreale et al. [11] mentioned one of the most appreciated benefits: the increase of adherence to rehabilitation protocols.
The multitude of scientific contributions fostering telerehabilitation exploits
new technologies and various architectures to better understand and serve user requirements. However, due to technological or technical limitations, physiotherapists’ needs have not yet been completely satisfied. To fill this gap, a system evolution is required. For example, telerehabilitation systems cannot offer the same behavior to users with diverse conditions. Viceversa, according to the environment condition, they must rather be able to adapt themselves to the user needs [6].
Telerehabilitation is characterized by a very delicate equilibrium between
environment, devices, and users. Thus, the capabilities such as self adaptation, flexibility, and ubiquity are crucial to facilitate and promote the usability and then the actual practices.
Agent-based systems for telerehabilitation: strengths, limitations and future challenges (PDF Download Available). Available from: https://www.researchgate.net/publication/316790326_Agent-based_systems_for_telerehabilitation_strengths_limitations_and_future_challenges [accessed May 26, 2017].

Continue —> Agent-based systems for telerehabilitation: strengths, limitations and future challenges (PDF Download Available)

Fig. 2. Agent-based sensing: future challenge for telerehabilitation MAS. 

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