Archive for category Tele/Home Rehabilitation

[Abstract+References] A Home-Based Telerehabilitation Program for Patients With Stroke 

Background. Although rehabilitation therapy is commonly provided after stroke, many patients do not derive maximal benefit because of access, cost, and compliance. A telerehabilitation-based program may overcome these barriers. We designed, then evaluated a home-based telerehabilitation system in patients with chronic hemiparetic stroke. Methods. Patients were 3 to 24 months poststroke with stable arm motor deficits. Each received 28 days of telerehabilitation using a system delivered to their home. Each day consisted of 1 structured hour focused on individualized exercises and games, stroke education, and an hour of free play. Results. Enrollees (n = 12) had baseline Fugl-Meyer (FM) scores of 39 ± 12 (mean ± SD). Compliance was excellent: participants engaged in therapy on 329/336 (97.9%) assigned days. Arm repetitions across the 28 days averaged 24,607 ± 9934 per participant. Arm motor status showed significant gains (FM change 4.8 ± 3.8 points, P = .0015), with half of the participants exceeding the minimal clinically important difference. Although scores on tests of computer literacy declined with age (r = −0.92; P < .0001), neither the motor gains nor the amount of system use varied with computer literacy. Daily stroke education via the telerehabilitation system was associated with a 39% increase in stroke prevention knowledge (P = .0007). Depression scores obtained in person correlated with scores obtained via the telerehabilitation system 16 days later (r = 0.88; P = .0001). In-person blood pressure values closely matched those obtained via this system (r = 0.99; P < .0001). Conclusions. This home-based system was effective in providing telerehabilitation, education, and secondary stroke prevention to participants. Use of a computer-based interface offers many opportunities to monitor and improve the health of patients after stroke.

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Source: A Home-Based Telerehabilitation Program for Patients With StrokeNeurorehabilitation and Neural Repair – Lucy Dodakian, Alison L. McKenzie, Vu Le, Jill See, Kristin Pearson-Fuhrhop, Erin Burke Quinlan, Robert J. Zhou, Renee Augsberger, Xuan A. Tran, Nizan Friedman, David J. Reinkensmeyer, Steven C. Cramer, 2017

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[Abstract] Fuzzy logic-based mobile computing system for hand rehabilitation after neurological injury.  

Abstract

BACKGROUND:

Effective neurological rehabilitation requires long term assessment and treatment. The rapid progress of virtual reality-based assistive technologies and tele-rehabilitation has increased the potential for self-rehabilitation of various neurological injuries under clinical supervision.

OBJECTIVE:

The objective of this study was to develop a fuzzy inference mechanism for a smart mobile computing system designed to support in-home rehabilitation of patients with neurological injury in the hand by providing an objective means of self-assessment.

METHODS:

A commercially available tablet computer equipped with a Bluetooth motion sensor was integrated in a splint to obtain a smart assistive device for collecting hand motion data, including writing performance and the corresponding grasp force. A virtual reality game was also embedded in the smart splint to support hand rehabilitation. Quantitative data obtained during the rehabilitation process were modeled by fuzzy logic. Finally, the improvement in hand function was quantified with a fuzzy rule database of expert opinion and experience.

RESULTS:

Experiments in chronic stroke patients showed that the proposed system is applicable for supporting in-home hand rehabilitation.

CONCLUSIONS:

The proposed virtual reality system can be customized for specific therapeutic purposes. Commercial development of the system could immediately provide stroke patients with an effective in-home rehabilitation therapy for improving hand problems.

Source: Fuzzy logic-based mobile computing system for hand rehabilitation after neurological injury. – PubMed – NCBI

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[Abstract] A novel smartphone camera-LED Communication for clinical signal transmission in mHealth-rehabilitation system – IEEE Conference Publication

Abstract:

In this paper, an implementation of mobile-Visible Light Communication (mVLC) technology for clinical data transmission in home-based mobile-health (mHealth) rehabilitation system is introduced. Mobile remote rehabilitation program is the solutions for improving the quality of care of the clinicians to the patients with chronic condition and disabilities. Typically, the program inquires routine exercise which obligate patients to wear wearable electronic sensors for hours in a specific range of time. Thus it motivate us to develop a novel harmless biomedical communicating system since most of the device’s protocol was based on RF communication technology which risky for a human body in term of long term usage due to RF exposure and electromagnetic interference (EMI). The proposed system are designed to utilize a visible light as a medium for hazardless-communication between wearable sensors and a mobile interface device (smartphone). Multiple clinical data such as photoplethysmogram (PPG), electrocardiogram (ECG), and respiration signal are transmitted through LED and received by a smartphone camera. Furthermore, a smartphone also used for local interface and data analyzer henceforth sent the data to the cloud for further clinician’s supervision.

I. Introduction

Home-based rehabilitation are focused to improve the care quality of the clinicians to the patients. It helps the medical experts and clinicians to monitor their patients without direct interaction to the patients. For patients, it helps them to keep the intense care of their clinical states while being at home and also helps some patients with inability to leave their home to easily interact with their doctor for treatment. Basically each individual patients and diseases have different rehabilitation treatment, such as smart exercise bike for Parkinson’s disease [1], cycling exercise for chronic disease [2], seated exercises for older adults [3], and movement disorders patients [4], also hand exercise for postStroke patients [5]. Most of the mentioned rehabilitation program are required a regular time of exercise treatment, for example based on American Heart Association / American Stroke Association (AHA/ASA) guideline [6], for inpatient rehabilitation facilities (IRFs) at least 3 hours/day with 5 days/week is required. Moreover other researcher [7], mentioned the same treatment timeline requirement for their proposed home stroke rehabilitation and monitoring system.

Source: A novel smartphone camera-LED Communication for clinical signal transmission in mHealth-rehabilitation system – IEEE Conference Publication

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[Conference paper] Kushkalla: A Web-Based Platform to Improve Functional Movement Rehabilitation – Full Text

Abstract

Telerehabilitation is a growing alternative to traditional face-to-face therapy, which uses technological solutions to cover rehabilitation care in both clinical centers and in-home programs. However, the current telerehabilitation systems are limited to deliver a set of exercise programs for some specific locomotor disability, without including tools that allow a quantitative analysis of the rehabilitation progress, in real-time, as well as the medical condition of patients. This paper presents the design and development of a novel web-based platform, named “Kushkalla”, that allows to perform movement assessment for creating personalized home-based therapy routines, integrating hardware and software tools for a quantitative analysis of locomotor movements based on motion capture, preprocessing, monitoring, visualization, storage and analysis, in real-time. The platform combines two motion capture strategies, the Kinect-based and IMU-based motion capture. In addition, a set of 2D and 3D graphical models, virtual environments, based on WebGL technology, and videoconference module are included to allow the interaction between user and clinician for enhancing the capability of the clinician to direct rehabilitation therapies.

Introduction

According to the World Health Organization, at least 15% of world people could present musculoskeletal disabilities, which present difficulties to access appropriate management even in diagnosis, treatment or follow-up stages. Particularly, it is estimated that between 76% and 85% of disabled people have not accessed to treatment programs in developing countries [17]. Conventionally, when a musculoskeletal disability is diagnosed, a clinical specialist designs a specific functional rehabilitation program, according to the analysis of the strength, flexibility and other biomechanical aspects of the patient; then, a team of therapists is responsible for its execution and follow-up. Both diagnosis and follow-up require quantifying those biomechanical aspects in order to guarantee that the designed program is suitable for the patient. This workflow demands an important number of therapists and technologies, such as strength platforms, to ensure the quality of the rehabilitation program. Additionally, the patient location could be a major obstacle for this purpose. This is the case of some rehabilitation programs to restore functional movements of elderly people, which are constantly suffering locomotor impairment caused by aging. Thus, functional movement rehabilitation programs evaluate the movement patterns from each patient to establish what parts of the human body may be treated. An improper movement pattern or imbalances throughout the human body allow determining postural and motor issues, which are used to develop different rehabilitation programs by the therapist. Therefore, functional movement rehabilitation programs are able to rehabilitate the human body that is weak, tight or unbalance by using a combination of functional movement correction and classic rehabilitation exercises.

Recently, telerehabilitation has emerged as an alternative that allows to perform functional movement rehabilitation activities from the comfort of the patient location, which are monitored by the physician from the specialized medical center [14]. This is possible by the use of the Internet and emerging technologies such as inertial sensors, optical motion capture devices, robots, virtual reality environments, among others [4]. In general, telerehabilitation strategies can be classified as: telepresence-based rehabilitation, which are supported by videoconference tools that allow a continuous communication between patient and physician [3]; robotic-based rehabilitation, which uses autonomous robots or exoskeletons for guiding patient movements [7]; interactive-based rehabilitation, which uses interactive environments for motivating patient to perform exercises while playing [121521] and; rehabilitation based on a precision analysis, which provides movement analysis tools for supporting the physician decisions [11].

This paper describes the design and development of a novel web-based platform that integrates telepresence, interactive environments, and movement analysis tools, for providing the technology to carry out functional movement assessment and to create personalized home-based therapy routines. The proposed Web-based platform was developed on a service-oriented architecture (SOA), a client/server software design approach in which an application consists of software services and software service consumers that are provided between software components through several network communication protocols [16]. It is composed of two main software parts: a client and a cloud server components. Additionally, two applications conform the client component: the patient application, and the physician application. The patient application includes a bimodal human motion capture module that allows to integrate both a wearable inertial sensor system and a depth camera sensor (Kinect); a visualization module provided with a virtual environment with an interactive interface in which patient can see in two 3D avatars how an exercise must be executed and how they execute it; and an assistance module provided with a videoconference tool and videotutorials about the platform. The Physician application includes an exercise visualization module, synchronized with the patient interface, in which real-time patient movements are displayed, and a motion analysis module, which displays graphically the movement measurements generated by the analysis of captured data. Finally, the server component, implemented as a software as a service cloud component that it includes a web-server, a websocket server, a webRTC (web with Real-Time Communications) server, and relational and non-relational databases.

This paper is organized as follows. The next section presents a brief summary of related works. In the Sect. 3 the main hardware/software components of the proposed platform are described. Section 4 presents a preliminary evaluation that shows the reliability of the proposed architecture and finally, Sect. 5 presents the conclusions and discuss the future work.[…]

Continue —>  Kushkalla: A Web-Based Platform to Improve Functional Movement Rehabilitation | SpringerLink

Fig. 1. General framework of Kushkalla: Telerehabilitation platform

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[WEB SITE] SMARTmove – FES

Summary

SMARTmove is a £1.1 million Medical Research Council research project running for 30 months from September 2016 to February 2019, funded under the Development Pathway Funding Scheme (DPFS). The project brings together a multidisciplinary team with expertise in functional materials, direct printing fabrication, control algorithms, wireless electronics, sensors, and end user engagement to address stroke rehabilitation. Working together with the advisory board members from six institutions, we will deliver a personalised wearable device for home-based stroke upper limb rehabilitation.

     

The Need

Stroke is one of the largest causes of disability: 17 million strokes occur every year worldwide, meaning one stroke every two seconds. Half of stroke survivors lose the ability to perform everyday tasks with their upper limb, which affects their independence. The cost to society in the UK is nine billion pounds per year due to health and social care, informal care, productivity loss and benefit payments. As stroke is an age-related disease, these numbers are set to increase as the population ages.

Novelty

Current commercial devices using functional electrical stimulation (FES) have large electrodes that only stimulate a limited number of muscles, resulting in simple, imprecise movements and the rapid onset of fatigue. In addition, current commercial devices do not employ feedback control to account for the movement of patients, only reducing the level of precision in the resulting movements. In addition, devices are either bulky and expensive, or difficult to set-up due to trailing wires.

Our project uses bespoke screen printable pastes to print electrode arrays directly onto everyday fabrics, such as those used in clothing. The resulting garments will have cutting-edge sensor technologies integrated into them. Advanced control algorithms will then adjust the stimulation based on the patients’ limb motion to enable precise functional movements, such as eating, washing or dressing.

Impact

This project will deliver a fabric-based wearable FES for home based stroke rehabilitation. The beneficiaries include:

  1. Persons with stroke (PwS) and other neurological conditions. Stroke survivors are the direct beneficiaries of our research. The FES clothing can be adapted to also treat hand/arm disabilities resulting from other neurological conditions such as cerebral palsy, head injury, spinal cord injury, and multiple sclerosis. The use of the wearable training system increases the intensity of rehabilitation without an increase in clinical contact time. This leads to better outcomes such as reduced impairment, greater restoration of function, improved quality of life and increased social activity.
  2. The NHS. FES-integrated clothing is comfortable to wear and convenient to use for rehabilitation, enabling impaired people to benefit from FES at home. It will transfer hospital based professional care to home based self-care, and therefore will reduce NHS costs by saving healthcare professionals’ time and other hospital resources.
  3. Industry. Benefits include: bringing business to the whole supply chain; increasing the FES market demand by improving performance; benefiting other industry sectors such as rehabilitation for other neurological conditions.
  4. Research communities in related fields. Specifically, the fields of novel fabrication, control systems, design of medical devices, rehabilitation, smart fabrics, and remote healthcare will benefit from the highly transformative platform technology (e.g. direct write printing, fabric electrodes, iterative learning control systems) developed in this work.

What is FES?

Functional electrical stimulation (FES) is a technique used to facilitate the practice of therapeutic exercises and tasks. Intensive movement practice can restore the upper limb function lost following stroke. However, stroke patients often have little or no movement, so are unable to practice. FES activates muscles artificially to facilitate task practise and improve patients’ movement.

More…..

Source: SMARTmove

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[Abstract] Providing Sources of Self-Efficacy Through Technology Enhanced Post-Stroke Rehabilitation in the Home.

Abstract

This research explores the impact of receiving feedback through a Personalised Self-Managed Rehabilitation System (PSMrS) for home-based post-stroke rehabilitation on the users’ self-efficacy; more specifically, mastery experiences and the interpretation of biomechanical data. Embedded within a realistic evaluation methodological approach, exploring the promotion of self-efficacy from the utilisation of computer-based technology to facilitate post-stroke upper-limb rehabilitation in the home included; semi-structured interviews, quantitative user data (activity and usage), observations and field notes. Data revealed that self-efficacy was linked with obtaining positive knowledge of results feedback. Encouragingly, this also transferred to functional activities such as, confidence to carry out kitchen tasks and bathroom personal activities. Findings suggest the PSMrS was able to provide key sources of self-efficacy by providing feedback which translated key biomechanical data to the users. Users could interpret and understand their performance, gain a sense of mastery and build their confidence which in some instances led to increased confidence to carry out functional activities. However, outcome expectations and socio-structural factors impacted on the self-efficacy associated with the use of the system. Increasing the understanding of how these factors promote or inhibit self-management and self-efficacy is therefore crucial to the successful adoption of technology solutions and promotion of self-efficacy.

Source: Providing Sources of Self-Efficacy Through Technology Enhanced Post-Stroke Rehabilitation in the Home. – PubMed – NCBI

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[BLOG POST] Virtual reality for people with stroke or Parkinson’s disease: bringing therapy home – Evidently Cochrane

Virtual reality for people with stroke or Parkinson’s disease: bringing therapy home

BY 

In this blog, neuropsychologist Marta Bieńkiewicz explores the potential of virtual reality to help people with Parkinson’s disease, and after stroke, and looks at the evidence from Cochrane reviews.

By 2020 it is estimated that there will be 120 million active users of Virtual Reality (VR) via mobile headsets; nearly a fifth of whom will be using it for healthcare solutions (ABI report, 2015). The hype about VR is currently reaching fever pitch, thanks mostly to the increased accessibility of it for the average Joe (via solutions such as smartphones add-ons spectacles). All over the globe VR setups are being tested and investigated as a novel means of enabling more fun and efficient physical exercise as part of rehabilitation. But is all the money that goes into research and development for this technology justifiable? Could it be better spent – for example on training more therapists or providing activity groups for patients?

In an attempt to answer this question, let’s walk through some facts to get a better picture as to what VR is and what it might hold for people with stroke and Parkinson’s disease (PD).

The virtual reality (VR) environment

My first exposure to VR was during my PhD days. My future husband (as it turned out 5 years later) was doing his doctorate on the non-clinical applications of what was, at the time, a technology in its infancy. In the simplest of definitions, VR is a computer designed environment that can be displayed in a headset glasses or a cave (special room) to create a feeling of full immersion that you are somewhere else; completely detached from the real world yet fully engaged with the virtual world. The high immersion display might trick you into thinking you are on a tennis court playing a game at Wimbledon for example. The low immersion VR environments comprise computer displays – usually tablets or regular screens. In this case you can still enjoy a game or follow on-screen instructions, but your brain keeps check of its whereabouts.

So, the main concept behind VR-based rehabilitation games is twofold. Firstly, they provide a clear, visual means of prompting users’ movements (i.e. in the example of picking up an apple, the user might be guided toward it). Secondly, they increase the personal motivation of the user. The higher the engagement with the environment and varied scenarios, the higher the enjoyment and willingness to repeat the same exercise all over again (Lewis & Rosie, 2012). A Cochrane review (French et al. 2016) reported that repetitive training may improve walking distance and is probably effective for improving upper limb rehabilitation. For a fantastic example of how this field is moving forward see the KATA project based at John Hopkins University which uses a combination of VR (Pixar like!) display with robotic-assisted therapy for stroke.

The reality of stroke and Parkinson’s disease

Stroke and Parkinson’s disease are two different neurological conditions. The first one happens suddenly and changes mobility overnight, which may mean changing from being a fully active person to being limited in one’s independence. The second is characterised by gradual and sneaky progression of compromised mobility. Either condition may make everyday life increasingly a real struggle. When it is not easy to get dressed, the idea of doing physical exercise seems totally unattainable. People find themselves not being able to do the tasks they previously took for granted – preparing a sandwich, driving a car, or simply going out of the house, and now add to it catching up with the modern technology.

Exercise may help

If you are a sufferer, these two aspects might discourage you from reading on – exercise and VR sounds too hard to even bother! But here is the thing. While guidelines on how to improve mobility in neurological conditions are scarce, the ones that are there (Keus et al., 2014)suggest that the power of exercise might help. Studies suggests that intense exercise in Parkinson’s may slow down the progression of the disease due to neuroprotective benefits (Alberts et al., 2016Corcos et al., 2013) and help maintain independence (van Nimwegen, 2011). After stroke, physiotherapy is usually started straight away or during the hospitalisation period. In fact, many research teams are convinced that the time window for the real functional recovery of lost limb power (i.e. regaining the previous dexterity) is quite short and is limited to 6 months post accident or shorter (Cortes et al., 2017). This is the window of opportunity for brain reorganisation, after which improvement is maybe not impossible, but certainly more challenging.

Depending on patients’ needs, exercise should target general mobility, dexterity, walking, or specific daily activities. There are exercise-based interventions in particular that were reported to show improvement in people with Parkinson’s Disease: such as tandem or automated stationary cycling (Ridgiel et al., 2015) and pole-striding (Bombieri et al., 2017Krishnamurthi et al., 2017), and for stroke: physical rehabilitation (Pollock et al., 2014) or robot-assisted interventions (Mehrholz et al., 20152017). In both conditions, it is thought to be important to start as soon as possible and introduce exercise regime as a regular part of daily life.

For people with PD or after stroke who are keen to become more fit and actively steer their rehabilitation, VR could be their new best friend.

Does virtual reality offer real life benefits?

The Cochrane review of VR (Dockx et al., 2016) and gaming for Parkinson’s, with a focus on walking and balance, provides us with evidence that VR based training may lead to better improvements for stride length, but overall may have similar effects on walking parameters and balance as conventional therapy, while the effect on quality of life is uncertain. The upper limb interventions were not included.

On the contrary, the Cochrane review of VR in stroke focused interventions (Laver et al., 2015) was primarily focused on upper limb function and found that VR based interventions may lead to greater improvements in both function and daily task performance compared to conventional therapy. Global mobility and grip strength remained on level par. It is not clear how long-lasting those effects are, nor which characteristics are the most meaningful for patients’ recovery. The number of studies examined was small and information insufficient to look into other dimensions such as quality of life or cognitive functions.

So what does this all mean? The interventions using VR were overall found to be probably similar to the conventional therapies, with the potential added value in the form of accurate feedback and the ability to stimulate users by creating personalised, motivational and fun interventions (Dockx et al., 2016Laver et al., 2015). If more evidence is found to confirm those findings, it would mean VR can be potentially be as good as a supervised therapy, which is great news. Why? Because it means you can bring it home.

Why Occupational Therapists can sleep well at night (for now…)

Let’s make it clear, this is not an overnight take-over of conventional therapy. VR and gaming solutions have the potential to provide a similar level of care to traditional exercise-based therapy, without having to replace it. At least for the next decades, think of it as a potential complementary therapy subsidised by the NHS or private insurance: part of a medical treatment that would encourage patients to do meaningful exercise in between the supervised physiotherapy sessions. Conversely, VR-based exercise units in hospitals could train patients in daily tasks, emulating their home environment. Beyond that, the technology is simply not mature enough to match that of a human eye and brain in terms of assessment and choice of best treatment. However, with Artificial Intelligence looming on the distant horizon, this is not beyond the realms of possibility…some day.

Tread carefully though when it comes to any products or apps that are advertised as a rehabilitation tool on the consumer market. In order for it to be a relevant training tool it needs to be paired with sensors (attached to your body or embedded in a special clothing) in order to provide feedback.

Looking to the future: Extended Reality

The future however, might lie in a newly born sister of VR, namely Extended Reality (ER). This technology is also based on wearable headsets (such as Hololens) but allows the user to be immersed in the virtual reality while seeing the physical environment.

The idea is that the juxtaposed feedback information is relevant and not interruptive for your current activity (e.g. walking a dog). It is also a safer mode of exercise as it does not require being detached from one’s surroundings despite a high level of immersion in the virtual environment/of immersion. At least four labs so far have been investigating this idea for stroke and Parkinson’s (Technical University of MunichUniversity of RochesterUniversity of Connecticut and Northeastern University). Along with ER developments, the level of immersion and therefore enjoyment can be increased with the sound spatialisation and touch sensation (i.e. Ultrahaptics). One could easily imagine that ER opens new horizons for combining a very accurate feedback tool with, for example, robotic therapy.

Hopefully the next years will bring answers to questions such as the level of transferability of VR/ER training into real life skills. Further research is necessary to inform tailored technology-based exercise regimes and to clarify whether or not rehabilitation with limited supervision is a feasible model.

The take home message

While certainly the technological development in the current era is both exciting and a little daunting, it brings solutions that were not previously available at such affordable cost. VR essentially offers a therapy that is likely to become almost as good as conventional therapy from within the comforts of your own home. VR and gaming can be fun, can provide excitement of immersion and prevent boredom while also achieving exercise goals for task-specific rehabilitation. While current solutions are not yet up to the ‘buy now’ level, this area should definitely make your watchlist.

References may be found here.

Marta Bieńkiewicz has nothing to disclose.

Source: Virtual reality for people with stroke or Parkinson’s disease: bringing therapy home – Evidently Cochrane

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[Abstract] Autonomous rehabilitation at stroke patients home for balance and gait: safety, usability and compliance of a virtual reality system.

Abstract

Background: New technologies, such as telerehabilitation and gaming devices offer the possibility for patients to train at home. This opens the challenge of safety for the patient as he is called to exercise neither with a therapist on the patients’ side nor with a therapist linked remotely to supervise the sessions.

Aim: To study the safety, usability and patient acceptance of an autonomous telerehabilitation system for balance and gait (the REWIRE platform) in the patients home.

Design: Cohort study.

Setting: Community, in the stroke patients’ home.

Population: 15 participants with first-ever stroke, with a mild to moderate residual deficit of the lower extremities.

Method: Autonomous rehabilitation based on virtual rehabilitation was provided at the participants’ home for twelve weeks. The primary outcome was compliance (the ratio between days of actual and scheduled training), analysed with the two-tailed Wilcoxon Mann- Whitney test. Furthermore safety is defined by adverse events. The secondary endpoint was the acceptance of the system measured with the Technology Acceptance Model. Additionally, the cumulative duration of weekly training was analysed.

Results: During the study there were no adverse events related to the therapy. Patients performed on average 71% (range 39 to 92%) of the scheduled sessions. The Technology Acceptance Model Questionnaire showed excellent values for stroke patients after the training. The average training duration per week was 99 ±53min.

Conclusion: Autonomous telerehabilitation for balance and gait training with the REWIRE-system is safe, feasible and can help to intensive rehabilitative therapy at home.

Clinical Rehabilitation Impact: Telerehabilitation enables safe training in home environment and supports of the standard rehabilitation therapy.

Read Article at publisher’s site

Source: Autonomous rehabilitation at stroke patients home for balance and gait: safety, usability and… – Abstract – Europe PMC

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[ARTICLE] Telephysiotherapy: time to get online – Full Text

The science and practice of telehealth have undergone rapid growth in recent years. A search of the Web of Science for the term ‘telehealth’ would have returned only two papers in 1995, compared with 104 papers in 2000, and 5069 papers in June 2017. This exponential growth is also evident in the number of randomised, controlled trials and systematic reviews indexed in the Physiotherapy Evidence Database with ‘telehealth’ in the title, rising from 10 records in 2008 to 70 records in 2017. These papers span the breadth of physiotherapy practice, with particularly strong representation from musculoskeletal and cardiorespiratory physiotherapy (Figure 1). High-quality randomised, controlled trials that support the benefits of telehealth interventions in many physiotherapy subdisciplines have been published over recent years. These have included telephysiotherapy interventions for chronic knee pain,1 non-specific low back pain,2 chronic obstructive pulmonary disease (COPD),3 heart disease,4 breast cancer,5 joint arthroplasty,6 and urinary incontinence.7Many of these studies have demonstrated significantly better clinical outcomes than usual care that did not include physiotherapy, including improved exercise capacity, better physical function, reduced symptoms and enhanced health-related quality of life.

Figure 1 Number of randomised trials and systematic reviews indexed on the Physiotherapy Evidence Database (PEDro) that have a telehealth element, categorised by subdiscipline. Articles were identified using the search terms tele or internet, with screening by title and abstract to confirm a telehealth element. Subdiscipline categorisations are those on the PEDro website, with some articles categorised under more than one subdiscipline.

Telephysiotherapy can take many different forms, with the components driven by the goals of treatment. Videoconferencing provides direct contact between patients and physiotherapists, either one-to-one1 or in a virtual group setting.3 For some telephysiotherapy programs (eg, pulmonary rehabilitation, stroke rehabilitation) it may be necessary to perform a limited number of home visits, in order to perform assessments or provide instruction in the use of equipment.3, 8 However, some telephysiotherapy programs are delivered entirely from a distance, without ever meeting the patient in person, including notable examples of successful treatment of stress urinary incontinence using email support7 and a mobile app.9 Telephysiotherapy programs may include remote monitoring of physiological signals, such as pulse rate, oxygen saturation, electrocardiograms (ECG), and joint range of movement, in specific populations such as cardiorespiratory or orthopaedic disease.4, 10, 11Whilst some telephysiotherapy models require specially designed equipment,6, 11 others have achieved similarly successful outcomes with off-the-shelf consumer devices and software.1, 3 The ubiquitous nature of the smartphone provides new opportunities for telephysiotherapy, including: physical activity monitoring; sound and light cues to set exercise intensity and duration; real-time feedback on exercise performance; and text messaging to provide exercise advice or progression.10, 12 Simple web-based diaries can be used to record exercise and provide feedback.12 Didactic or interactive education programs can also be provided.1 In some populations it may be possible to automate aspects of a telephysiotherapy program to provide efficient and effective care to large patient populations, for instance using internet platforms that provide automated goal setting and feedback in conjunction with a pedometer for patients with non-specific low back pain.2

The increase in our capacity to deliver physiotherapy at a distance using telehealth has occurred at the same time that ‘hands-on’ physiotherapy techniques have become less important for some health conditions. For example, electrotherapy is no longer recommended for routine treatment of low back pain,13 whereas exercise therapy is an important component of care.14 Interventions designed to increase physical activity and physical fitness now have an important role in physiotherapy management for numerous clinical groups and across the lifespan, recognising the critical impact of these factors on long-term health outcomes.15 Many of these interventions, which typically involve goal setting, exercise prescription and self-management training, do not require hands-on therapy and are highly amenable to telephysiotherapy.

Despite the potential for telehealth to increase the capacity of the health system and deliver better health outcomes, there has been relatively slow uptake in practice. Enthusiasm has been tempered by the lack of clinically relevant benefits seen in some large-scale randomised trials involving people with chronic diseases such as heart failure and COPD;16, 17, 18 however, these trials relied heavily on telemonitoring of physiology and symptoms, rather than on delivery of therapy. Remote monitoring has not delivered consistent benefits over usual care, perhaps because it is difficult to maintain long-term adherence with monitoring, or the difficulty in identifying meaningful changes in monitored variables. Trials in telephysiotherapy, which typically involve delivering a treatment from a remote location, have generally been more successful, producing similar results to interventions that are delivered face to face. For instance, in 205 patients who had undergone knee arthroplasty, in-home rehabilitation delivered by videoconference demonstrated equivalent outcomes for pain, stiffness and function when compared with face-to-face rehabilitation.6 Similarly, in 152 people with heart failure, cardiac rehabilitation with exercise prompts and ECG monitoring transmitted via a mobile phone produced similar benefits to a traditional outpatient cardiac rehabilitation program.10 A key feature of these successful telephysiotherapy interventions is that they delivered treatments of known effectiveness in a different way, using technology to reach patients who are located away from healthcare facilities. […]

CONTINUE —>Telephysiotherapy: time to get online – Journal of Physiotherapy

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[Abstract] Quantification method of motor function recovery of fingers by using the device for home rehabilitation – IEEE Conference Publication

Abstract:

After leaving hospital, patients can carry out rehabilitation by using rehabilitation devices. However, they cannot evaluate the recovery by themselves. For this problem, a device which can both carry out the rehabilitation and evaluation of the degree of recovery is required. This paper proposes the method that quantifies the recovery of the paralysis of fingers to evaluate a patient automatically. A finger movement is measured by a pressure sensor on the rehabilitation device we have developed. A measured data is used as a time-series signal, and the recovery of the paralysis is quantified by calculating the dissimilarity between a healthy subject’s signal and the patient’s signal. The results of those dissimilarities are integrated over all finger to be used as a quantitative scale of recovery. From the experiment conducted with hemiplegia patients and healthy subjects, we could trace the process of the recovery by the proposed method.

Source: Quantification method of motor function recovery of fingers by using the device for home rehabilitation – IEEE Conference Publication

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