Archive for category Tele/Home Rehabilitation

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

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: [accessed May 26, 2017].

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

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[Abstract+References] A therapy-driven gamification framework for hand rehabilitation


Rehabilitative therapy is usually very expensive and confined to specialized rehabilitation centers or hospitals, leading to slower recovery times for corresponding patients. Therefore, there is a high demand for the development of technology-based personalized solutions to guide and encourage patients towards performing online rehabilitation program that can help them live independently at home. This paper introduces an innovative e-health framework that develops adaptive serious games for people with hand disabilities. The aim of this work is to provide a patient-adaptive environment for the gamification of hand therapies in order to facilitate and encourage rehabilitation issues. Theoretical foundations (i.e., therapy and patient models) and algorithms to match therapy-based hand gestures to navigational movements in 3D space within the serious game environment have been developed. A novel game generation module is introduced, which translates those movements into a 3D therapy-driven route on a real-world map and with different levels of difficulty based on the patient profile and capabilities. In order to enrich the user navigation experience, a 3D spatio-temporal validation region is also generated, which tracks and adjusts the patient movements throughout the session. The gaming environment also creates and adds semantics to different types of attractive and repellent objects in space depending on the difficulty level of the game. Relevant benchmarks to assess the patient interaction with the environment along with a usability and performance testing of our framework are introduced to ensure quantitative as well as qualitative improvements. Trial tests in one disability center were conducted with a total number of five subjects, having hand motor controls problems, who used our gamified physiotherapy solution to help us in measuring the usability and users’ satisfaction levels. The obtained results and feedback from therapists and patients are very encouraging.

Source: A therapy-driven gamification framework for hand rehabilitation | SpringerLink

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[WEB SITE] Undergoing physiotherapy exercises from home now a reality for patients

SINGAPORE: Patients from two healthcare institutions across Singapore will be able to carry out physiotherapy exercises in the comfort of their own homes, after a national tele-rehabilitation pilot was launched on Friday (May 5) by Integrated Health Information Systems (IHiS).

IHiS, Singapore’s healthcare technology agency, developed the system together with T-Rehab, a start-up founded by researchers from the National University of Singapore (NUS). 

To use the service, patients open an app on an iPad – called Smart Health TeleRehab – and put on neck and limb sensors, depending on which part of the body they are exercising. The instructions are available in five languages: English, Mandarin, Bahasa Melayu, Tamil and Tagalog. 

Video demonstrations of the exercises prescribed by the therapists will then be played via the app. The therapist is able to customise the level of difficulty of each exercise, from the number of repetitions to the angle of each limb movement.

The patient’s movements are also recorded for the therapist to review, and to motivate the patient to complete his or her exercises, the system designed to have gaming elements. For instance, there are coloured bars to indicate if the patient has achieved the desired exercise angle, and a counter for the number of repetitions completed. 

After the patient completes the exercises, a record of the patient’s performance is sent to the therapist.

The service is available to those deemed suitable to perform physiotherapy exercises without the physical supervision of a physiotherapist. This includes those recovering from strokes, lower limb joint replacements and amputations, falls and fractures. 

It is currently offered by NTUC Health and TOUCH Home Care. Twelve other institutions including Ang Mo Kio-Thye Hua Kwan Hospital, Khoo Teck Puat Hospital, and the National University Hospital will provide the service by end-2017.

There are 200 sets of tele-rehabilitation equipment available, which is rented out to the healthcare institutions for a fee. IHiS hopes to get 1,000 patients on the programme by the end of the two-year pilot and currently has around 11 patients on the service since February this year, said Mr Chua Chee Yong, director of IHiS’ planning group.


This service comes two-and-a-half years after clinical trials were conducted by the researchers from T-Rehab. 

A total of 100 stroke patients were recruited from Ang Mo Kio-Thye Hua Kwan Hospital and the Singapore General Hospital since January 2014, said Dr Gerald Koh, an associate professor and the director of medical undergraduate education at Saw Swee Hock School of Public Health at NUS. He is one of the founders of T-Rehab. 

They chose to develop a tele-rehab system after an earlier study he conducted found that only two out of five patients wanted to continue with rehabilitation after discharge, he said. This is despite close to four out of five of them stating that rehabilitation was useful.

According to Dr Koh, many of them cited inconvenience, high costs and difficulty getting to the rehab centre without a caregiver as the main reasons why they stopped going for rehabilitation.

“The very reason why I need rehabilitation is the very reason why I can’t get to the day rehab centre three times a week,” Dr Koh said of the issue of immobility faced by patients. 

His study found that those who got therapy through tele-rehabilitation recovered as well as those who did their exercises with a therapist present. 

This new service, Dr Koh added, will help to boost rehabilitation participation rate and remove the barriers to carrying out physiotherapy and this will prevent their conditions from deteriorating further.

One of the early adopters of the system, TOUCH Home Care, found that the service benefits both patients and its healthcare workers since it implemented the system in March 2017.

For TOUCH Home Care, the price per session is still the same as a home visit at S$18. However, as the patient is able to carry out the exercises more frequently and at their own time, the hope is that he or she will recover faster and overall, fewer therapy sessions are required, said a physiotherapist at TOUCH Home Care Vivian Lim.

The operator’s therapists have also been more productive.

So far, they spend about 50 minutes on each tele-rehabilitation session, which include prescribing the exercise via the system, reviewing the elderly client’s exercise records and conducting video consultations or calling the patients to provide feedback. A home visit will typically take about 100 minutes, including time to travel from one home to another.

The sessions are not meant to substitute home visits entirely, said Ms Lim, but can replace some of the weekly sessions.

However, not all clients are able to benefit from the new service, as those with conditions such as chronic giddiness and seizures will not be able to perform their exercises without direct supervision, said Ms Rachel Lim, a senior occupational therapist from TOUCH Home Care. 

Some of the seniors also “lack confidence” in using technology, while others may not have the right caregivers at home. “There are some caregivers are also elderly who are frail (themselves), with sensory deficits…they can’t help put on the sensors,” said the occupational therapist.

TOUCH Home Care hopes to get 90 of its 300 clients using the remote rehabilitation tool by the end of this year. It now has seven on board.


The tele-rehabilitation service was developed in light of Singapore’s healthcare landscape, said IHiS’ Mr Chua.

“Our growing ageing population (means) we have more aged elderly in the community… more healthcare workers, including our therapists, are also getting older,” he said. This means that there will be greater demand for rehabilitation services, while there will be a growing need to “stretch our manpower resources”.

The service is one of three telemedicine initiatives that will begin this year. A remote vital signs monitoring system will launch later this year, while a national videoconferencing platform for healthcare services was launched in April.

Source: Undergoing physiotherapy exercises from home now a reality for patients

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[WEB SITE] ‘Telerehab’ system allows patients to do physiotherapy at home

SINGAPORE – It is a Friday afternoon and Mr Chin Tian Loke, 72, is watching a video on an iPad Air in his five-room flat in Jurong West. He mimics the movements of the person on screen, lifting his arm, which has a sensor attached to it at a 90-degree angle. A voice from the iPad then congratulates him: “Spectacular!”

It appears as though Mr Chin, a retired odd-job worker, is playing a game. But he is actually undergoing rehabilitation therapy, to help him gain strength in his limbs after he fell and broke his spinal tail bone in November last year.

Mr Chin is one of the first to try out a novel healthcare system, announced on Friday (May 5) by healthcare technology agency Integrated Health Information Systems (IHiS).

The system aims to make physiotherapy as painless as possible: by allowing patients to exercise at any time of the day, within the comfort of their own homes. This removes the need for a patient to commute to and from a rehabilitation centre and hopefully, boost participation rates in attendance for rehabilitative therapy, which would then prevent the chances of re-admission to hospital. As National University of Singapore’s Associate Professor Gerald Koh, who pioneered the system, noted: “Often, the reason why a patient needs therapy is the reason why the patient finds it hard to go for therapy.”

The solution is technology.

All that is required is an iPad and two sets of sensors – which will be loaned to the patient by the healthcare institution – and an open mind.

Believed to be the first of its kind,Smart Health TeleRehab, as the system is known, will enable Mr Chin’s physiotherapist from Touch Home Care to keep tabs on his exercise regime remotely. Each exercise session will be automatically recorded and saved to a digital cloud, which his therapist views within two working days.

If a patient has completed the prescribed exercises successfully, the physiotherapist can increase the difficulty of the exercises at the touch of a button. If not, she will call Mr Chin to guide him on the right way to do the exercises. If further explanation is required, the physiotherapist will pay him a home visit within the week.

Smart Health TeleRehab is currently being used by 11 patients at two healthcare providers – Touch Home Care and NTUC Health. But 12 more -including Changi General Hospital, Khoo Teck Puat Hospital, and SPD (formerly known as the Society for the Physically Disabled) – will come on board by the end of this year (2017), as Singapore ramps up programmes in line with its Smart Nation ambition.

An estimated 1,000 patients are expected to benefit from the pilot programme by the end of next year (2018). IHiS’ latest initiative follows its April roll-out of a video call system for medical consultations to six public healthcare institutions that enables patients to consult experts from the comfort of their homes.

Mr Chee Hong Tat, Senior Minister of State for Health, visited Mr Chin on Friday at his home to see how the Smart Health TeleRehab system could be deployed. He said: “Smart Health TeleRehab could transform how therapy services are delivered in Singapore. Patients will benefit from greater convenience, cost savings and better outcomes. Therapists and therapy service providers will also benefit from the productivity improvements.”

The cost of Smart Health TeleRehab sessions depends on the various healthcare institutions, and the subsidies that a patient qualifies for.

As a gauge, at Ang Mo Kio Thye Hua Kwan Hospital, which will run the programme from next month (June 2017), a patient can expect to pay between $3 and $50 for one Smart Health TeleRehab session. In comparison, a patient has to pay more than $80 for one treatment session at the centre (excluding transportation costs, which could go up to $75 per way), or more than $160 for a therapist to visit him at home.

Singapore’s therapists too, will benefit from productivity gains. In 2016, there were about 2,570 occupational and physiotherapists here. However, figures from the Health Ministry show that 53,000 patients had to undergo physiotherapy in 2014 – and the health authorities are only expecting this number to grow over the years as the population ages.

An initial study led by Prof Koh found that the system could help therapists reap productivity gains of more than 30 per cent. A telerehab session, on average, takes about 52 minutes. A therapy session conducted in the patient’s home, however, could stretch up to almost 80 minutes. So in the time that a therapist usually takes to see three patients the conventional way, the therapist can see four patients instead via the TeleRehab method.

Smart Health TeleRehab may not be suitable for all patients, such as those who have diabetes or other complications.But with more patients on the technological platform, it frees up therapists so they can have more face-time with more needy patients.

Singapore Management University’s (SMU) School of Information Systems’ Associate Professor Tan Hwee Pink volunteers with the Stroke Support Station (Singapore) and has an elderly father recovering from a complex hip fracture after a road accident last year. He welcomed the new platform as a timely one.

Despite the benefits, however, he pointed out that most patients recovering from an accident or stroke would have weakened mental strength. “This needs to be addressed for the patient to be motivated to do the rehab at home. As we know, patients tend to do what they are told in a controlled environment, but not necessarily so when they are in the home environment,” he added.

One possible way to do this is to allow more functions to be used on the iPads, such as watching TV or making calls, for example, he suggested.

Professor Atreyi Kankanhalli, from the department of information systems at the National University of Singapore’s School of Computing, said the TeleRehab method also give patients a greater sense of autonomy and control, as they can do the rehabilitation exercises on their own. She added: “With the increasing incidence of chronic diseases, shortage of healthcare professionals, and yet the availability of more intelligent technologies, healthcare is a prime sector that can benefit from Smart Nation initiatives – in addition to other key sectors such as transport, commerce, utilities, security and education.”

Source: ‘Telerehab’ system allows patients to do physiotherapy at home, Health News & Top Stories – The Straits Times

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[ARTICLE] Towards a New Wave of Telerehabilitation Applications – Full Text PDF


In recent years, new scenarios for experimenting telerehabilitation services have been opening thanks to the diffusion of the new technologies. The revolution brought about by the Internet of Things and Big Data Analytics is having an effect also in the field of telerehabilitation services. The literature has broadened in scope and grown in volume and, in certain aspects, the focus of research has changed in the last few years. This article examines the major changes that have come about in the field of telerehabilitation, which can essentially be divided into two main strands: low-cost end-user applications, and the integration of telerehabilitation services. We will briefly review the emerging investigations and experimentations in the field of telerehabilitation, analyzing the market trends in the sector and the commercial strategies of companies working in it, and aim to outline the most relevant challenges that exist for the delivery of effective and sustainable telerehabilitation services. Our opinion is that telerehabilitation currently represents a very promising field, although many questions still remain open, for which concrete and reliable answers are required. In this respect, we focus on a fundamental issue that underlies the field of telerehabilitation services, namely the influence that environment has on the effectiveness of treatment. In short, how can the type of environment affect the results of treatment?

The Telerehabilitation Scenario

Many different terms are used to designate the application of ICTs in the field of healthcare. The term medical informatics, first coined around 1970, was superseded at the end of the 1990s by eHealth, while, nowadays, telemedicine, tele health, and tele care are all used fairly interchangeably.

The main advantages of Telemedicine in healthcare are evident [1-3]. It is a form of secondary prevention encompassing services dedicated to persons classified as at risk or suffering from chronic diseases (e.g. diabetes or cardiovascular disease) who require a constant monitoring of vital parameters in order to reduce the risk of complications, such as that of blood glucose levels for diabetic patients. Meanwhile, Tele-diagnosis focuses on moving diagnostic information rather than the patient. Although a complete diagnosis cannot be performed exclusively through the use of ICT tools, computer-based systems can effectively support diagnostic processes, for example by giving the possibility of exchanging data amongst specialists and facilitating its communication.

Home health monitoring services utilise ITC-based technology to monitor patients in their homes by means of devices that measure vital data, such as blood pressure, glucose levels, pulse, blood oxygen levels, etc., and enable the transmission of this data to clinicians [4,5].

Recently, the concept of telerehabilitation has been introduced to refer to the provision of rehabilitation care at a distance. Telerehabilitation, or e-rehabilitation, is considered a subcomponent of the broader area of telemedicine [6], and can be divided into three main categories: image based telerehabilitation, sensor based telerehabilitation, and telerehabilitation based on virtual technologies [7]. Lately, the notion of social telerehabilitation has been introduced to distinguish the application of ICT to the social rehabilitation sphere [8,9].

Telerehabilitation is widely considered to be advantageous in the treatment of patients. Telerehabilitation services are seen as being a costeffective alternative to traditional rehabilitation services since they can be delivered at a distance, thus reducing the travel costs and difficulties for patients to receive care at a healthcare facility.

The increasing interest in telerehabilitation is closely related to the diffusion of the internet. Indeed, thanks to the internet, all traditional sectors, including healthcare, are going through processes of transformation in order to become more effective and accurate, as well as cheaper and more powerful.

Telerehabilitation solutions have been experimented in many areas, particularly that of rehabilitation following traumatic injury (for assessment, physical therapy, and monitoring). …

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[Abstract+References] Ubiquitous gamification framework for stroke rehabilitation treatment based on the web service


Every year a large number of people survives from the stroke. To overcome the muscular rigidity, the survivors should participate the rehabilitation program regularly. Above all things, the motivation of the survivors easily collapses and hinder the participating the rehabilitation program. As a consequence, finding a good motivator for individual survivors is an important task for the caregivers and the therapists. This paper utilizes an individualized game for a motivator and proposes a ubiquitous gamification framework for stroke rehabilitation using web-services. The framework provides a formal interface to embrace individualized games and devices and motivates the survivors to participate the rehabilitation process in daily life.


Management of Stroke Rehabilitation Working Group 2010. VA/DOD Clinical practice guideline for the management of stroke rehabilitation. Journal of rehabilitation research and development.
Lindberg, J., Kreuter, M., Persson, L. O., and Taft, C. 2014. Family Members’ Perspectives on Patient Participation in Spinal Cord Injury Rehabilitation. Int J Phys Med Rehabil. (2014)
Ren, Y., Wu, Y. N., Yang, C. Y., Xu, T., Harvey, R., and Zhang, L. Q. 2016. Developing a wearable ankle rehabilitation robotic device for in-bed acute stroke rehabilitation. IEEE Trans Neural Syst Rehabil Eng. 99 (2016), 1–1.  [doi>10.1109/TNSRE.2016.2584003]
Popović, M. D., Kostić, M. D., Rodić, S. Z., and Konstantinović, L. M. 2014. Feedback-mediated upper extremities exercise: increasing patient motivation in poststroke rehabilitation. Biomed Res Int. (2014).
Thikey, H., Grealy, M., Wijck, F. V., Barber, M., and Rowe, P. 2012. Augmented visual feedback of movement performance to enhance walking recovery after stroke: study protocol for a pilot randomised controlled trial. Trials. 13, 1 (2012), 1–7.  [doi>10.1186/1745-6215-13-163]
Jacobs, A., Timmermans, A., Michielsen, M., Plaetse, M. V., and Markopoulos, P. 2013. CONTRAST: gamification of arm-hand training for stroke survivors. CHI EA. ACM New York, NY, USA (2013), 415–420.  [doi>10.1145/2468356.2468430]
Wood, S. R., Murillo, N., Bach-y-Rita, P., Leder, R. S., Marks, J. T., and Page, S. J. 2003. Motivating, Game-Based Stroke Rehabilitation: A Brief Report. Top Stroke Rehabil. 10, 2 (2003), 134–140.  [doi>10.1310/WB09-PFYJ-7XRN-RU6W]
White, G. N., Cordato, D. J., O’Rourke, F., and Mendis, R. L. 2012. Validation of the Stroke Rehabilitation Motivation Scale: a pilot study. Asian J Gerontol Geriatr. 7 (2012), 80–87.
Cho, K. H., Lee, K. J., and Song, C. H. 2012. Virtual-Reality Balance Training with a Video-Game System Improves Dynamic Balance in Chronic Stroke Patients. Tohoku J. Exp. Med. 228, 1 (2012), 69–74.  [doi>10.1620/tjem.228.69]
Hondori, H. M., Khademi, M., and Lopes, C.V. 2012. Monitoring intake gestures using sensor fusion (Microsoft Kinect and inertial sensors) for smart home tele-rehab setting. 1st Annual IEEE Healthcare Innovation Conference of the IEEE EMBS. (2012).
Sin, H., and Lee, G. 2013. Additional Virtual Reality Training Using Xbox Kinect in Stroke Survivors with Hemiplegia. Am J Phys Med Rehabil. 92, 10 (2013), 871–880.  [doi>10.1097/PHM.0b013e3182a38e40]
Kinect for Xbox One official homepage
Cleveland. Wii Fit Nintendo game makes physical therapy fun
Wii Fit Plus official homepage
Lange, B. S., Flynn, S. M., and Rizzo, A. A. 2009. Initial usability assessment of off-the-shelf video game consoles for clinical game-based motor rehabilitation. Phys Ther Rev. 14, 5 (2009), 355–363.  [doi>10.1179/108331909X12488667117258]
Deutsch, J. E., Robbins, D., Morrison, J., and Bowlby, P. G. 2009. Wii-based compared to standard of care balance and mobility rehabilitation for two individuals post-stroke. Virtual Rehabilitation International Conference. (2009), 117–120.  [doi>10.1109/ICVR.2009.5174216]
Björk, G. S., and Rydmark, M. 2007. Game Design in Virtual Reality Systems for Stroke Rehabilitation. Stud Health Technol Inform. 125 (2007), 146–148.
Burke, J.W. et al. 2010. Designing engaging, playable games for rehabilitation. (2010).
Rand, D., Kizony, R., and Weiss, P. L. 2004. Virtual reality rehabilitation for all: Vivid GX versus Sony PlayStation II EyeToy. 5th ICDVRAT. (2004), 87–94.
Colombo, E., Pisano, F., and Mazzone, A. et al.2007. Design strategies to improve patient motivation during robot-aided rehabilitation. J Neuroeng Rehabil, 4, 3 (2007), 33–39.
Reese, G. 2012. The REST API Design Handbook. Amazon Digital Services. (2012)

Source: Ubiquitous gamification framework for stroke rehabilitation treatment based on the web service

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[WEB SITE] How It All Works – Brainworks

eRehabilitation™: The future of rehab!

One thing we know for certain is that the future of rehab is inseparable from the Internet. To be client–centred, we have to go where our clients are … and our clients are everywhere, throughout the community and all over the Internet. The growth and complexity of knowledge, research and evidence for best practices in health mirrors the growth of the Internet and its tools to disseminate information, to provide forums for eclectic interactions and informative discussions. Our clients are aptly at this intersection – they are at the centre and we need to meet them there. This intersection is a magical place; it‘s on fire with prolific activity.

We are the benefactors of a modern revolution: the intersection of advances in technology, creative interfaces and evidence-based therapies are taking healthcare to levels only dreamed of. “The motive behind the use of this technology is to maintain the essential qualities of the health-care interaction, while improving access by overcoming barriers such as economics, culture, climate, and geography,” (Rees, 2004).

Telehealth has been touted as the most significant contribution to health-care delivery systems of the future (Bashshur, 1997). eRehabilitation™, a component of telehealth, is a cutting-edge, yet flourishing means of delivering rehabilitation, psychological & mental health services.

At Brainworks, we have developed eRehabilitation™ as a comprehensive treatment platform that uses interactive audio, video, or data communications to provide rehabilitation services at a distance.


Does eRehabilitation™ work?

Absolutely – eRehabilitation™ is Evidence-Based: there is a growing literature base that demonstrates the efficacy of these interactive, online modalities.

There are several areas for which online guided therapy based on CBT could be regarded as empirically-supported (Andersson, 2009), including panic disorder, social anxiety disorder, posttraumatic stress disorder (PTSD), and mild to moderate depression. progress. Carlbring et al. (2005) found equivalent outcomes of individual face-to-face CBT and Internet CBT for panic disorder. In a trial on depression (Spek, Nyklıcek, et al., 2007) found no differences between live group treatment and Internet CBT.

A recent study by Matsura et al. (2002) investigated the interrater reliability of videoconferencing compared with face-to-face assessment interviews. Perfect agreement was obtained between both interviewing conditions. Glueckauf et al. (2002) assessed the effects of videoconferencing-based counselling compared with counselling using a speakerphone, and conventional, face-to-face counselling. The counselling was provided to 22 rural teenagers with epilepsy. All treatment conditions were associated with similar outcomes, including significant reductions in problem severity and frequency.

Day and Schneider (2002) conducted a comprehensive and methodologically sound study evaluating the delivery of brief CBT via videoconferencing. A sample of 80 clients with concerns ranging from weight concerns to personality disorders were randomly assigned to one of three treatment groups (face-to-face, two-way audio, or two-way video) or a waiting list control group. No significant differences were found between treatment groups across outcome measures and all three groups were significantly superior to the no-treatment group.

A number of studies have demonstrated the benefits of conducting assessments via the Internet. These include: ease of administration, collecting data, communicating findings to clients, cost efficiency, reaching disabled persons and those that live in the rural areas (EmmelKamp, 2005; Fischer & Freid, 2001; Naus, Phillip, & Samsi 2009;).


References available upon request. Please contact us for more information and literature to support your referral!

Source: How It All Works – Brainworks

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[WEB SITE] Press Release: New Move to Use Robots for Stroke Rehabilitation –

Due to the high costs of clinical neuro-rehabilitation, post stroke treatments are limited in all countries to only a few weeks to months after the stroke event. Any system aimed at pro-longing neuro-rehabilitation out of the clinics, for example at patients’ homes; that can use low cost treatments, addresses a major issue in our current health care management systems.

How SCRIPT will contribute:

The SCRIPT project will produce two prototype robotic devices, a passive‐actuated device and one actuated actively, both of which can be used in the stroke patient’s home. Provision of motivating and challenging therapeutic activities using a robotic hand and wrist rehabilitation device at home, will provide a chance for more frequent therapies and interactions. It is thought that such frequent interaction will further influence recovery at chronic phases of stroke rehabilitation.

The principal aims of SCRIPT are to:

• use such rehabilitative technologies at patient’s home to enable better management of chronic stroke patients
• focus on hand and wrist exercise; as this presents the least researched area with the most functional relevance and potential for contribution to personal independence.
• look at differences between passive and active actuated devices.
• provide an educational, motivational and engaging interaction, therefore making a therapy session more enjoyable for patients.
• focus on remote management and support of the patient.
• deduce from summative evaluation in this project, the impact on health and recovery and its potential cost implications.

The SCRIPT multidisciplinary team has existing expertise in all aspects of robot‐mediated therapy, clinical evaluation and interface design and usability. After their discharge from the hospital a patient can begin using the SCRIPT developed robotic tools at home. SCRIPT systems will be adaptive to the user requirements and provide immediate feedback to a patient on their performance. The feedback will also be provided to an “off-site” health care professional with in‐depth considerations for security and confidentiality, who can remotely monitor progress, making adjustments to the support that the device provides.

We believe that the SCRIPT systems will be beneficial to patient recovery and can assist with improving their quality of life. SCRIPT will reduce hospital and home visits for patients & carers, and therefore have a large impact on reducing hospital costs; improving the quality and standard of care.

The SCRIPT project is partially funded by the European Commission under the 7th Framework Programme. The project activities will last for 36 months.

The Project partners are:


R.U.ROBOTS LIMITED (RUR), United Kingdom
MOOG BV (MOOG), Netherlands

For any further information about project development and implementation, please contact:

Dr.Farshid Amirabdollahian
School of Computer Science
University of Hertfordshire
College Lane
Hatfield Herts AL10 9AB
United Kingdom
Ph: +44-1707286125

Further information can be found at:

See our links section for other media coverage from the press release

Source: Press Release: New Move to Use Robots for Stroke Rehabilitation |

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[Abstract] Tele-health, wearable sensors and the Internet. Will they improve stroke outcomes through increased intensity of therapy, motivation and adherence to rehabilitation programs?

Provisional Abstract
Background and Purpose
Stroke, predominantly a condition of older age, is a major cause of acquired disability in the global population and puts an increasing burden on healthcare resources. Clear evidence for the importance of intensity of therapy in optimizing functional outcomes is founded in animal models, supported by neuroimaging and behavioral research, and strengthened by recent meta-analyses from multiple clinical trials. However, providing intensive therapy using conventional treatment paradigms is expensive and sometimes not feasible due to patients’ environmental factors. This paper addresses the need for cost-effective increased intensity of practice and suggests potential benefits of telehealth (TH) as an innovative model of care in physical therapy.

Summary of Key Points
We provide an overview of TH and present evidence that a web-supported program used in conjunction with Constraint Induced Therapy (CIT), can increase intensity and adherence to a rehabilitation regimen. The design and feasibility testing of this web-based program, ‘LifeCIT’ is presented. We describe how wearable sensors can monitor activity and provide feedback to patients and therapists. The methodology for the development of a wearable device with embedded inertial measurement units and mechanomyography sensors, algorithms to classify functional movement, and a graphical user interface to present meaningful data to patients to support a home exercise program is explained.

Recommendations for Clinical Practice
We propose that wearable sensor technologies and TH programs have the potential to provide cost-effective, intensive, home-based stroke rehabilitation.

Source: JUST ACCEPTED: “Tele-health, wearable sensors and the Internet. Will they improve stroke outcomes through increased intensity of therapy, motivation and adherence to rehabilitation programs?” |

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[ARTICLE] User-centered design of a patient’s work station for haptic robot-based telerehabilitation after stroke – Full Text


Robotic therapy devices have been an important part of clinical neurological rehabilitation for several years. Until now such devices are only available for patients receiving therapy inside rehabilitation hospitals. Since patients should continue rehabilitation training after hospital discharge at home, intelligent robotic rehab devices could help to achieve this goal. This paper presents therapeutic requirements and early phases of the user-centered design process of the patient’s work station as part of a novel robot-based system for motor telerehabilitation.

1 Introduction

Stroke is one of the dominant causes of acquired disability [1] and it is the second leading cause of death worldwide [2]. The high incidence of the disease and the current demographic developments are likely to increase the number of stroke patients in the future. Most of the survivors have physical, cognitive and functional limitations and require intensive rehabilitation in order to resume independent everyday life [3]. Therefore, the main goal of motor rehabilitation is relearning of voluntary movement capability, a process which takes at least several months, some improvement can occur even after years. In the rehabilitation clinic, patients usually receive a daily intensive therapy program. However, for further improvement of motor abilities, severely affected patients are required to continue their rehabilitation training outside the rehabilitation settings, after being discharged from the rehabilitation clinic. Langhammer and Stanghelle [4] found that a lack of follow-up rehabilitation treatment at home leads to deterioration of activities of daily living (ADL) and to motor functions in general. A possible solution is an individualized and motivating telerehabilitation system in the patient’s domestic environment. Some studies [5], [6] have confirmed the advantage of home rehabilitation after stroke and showed that telerehabilitation received high acceptance and satisfaction, both from patients, as well as from health professionals [7]. Most of the existing telesystems [7], [8] are based on audio-visual conferencing or on virtual environments and contain rather simple software for monitoring patients’ condition. However, in neurological rehabilitation the sensorimotor loop needs to be activated by provision of physiological haptic feedback (touch and proprioception) [3].

Robot-based rehabilitation is currently one of the most prevalent therapeutic approaches. It is often applied in hospitals alongside conventional therapy and is beneficial for motor recovery [9]. Rehabilitation training including a haptic-therapy device may therefore be even more promising for home environments than non-haptic telerehabilitation. Several telerehabilitation systems, which include not only audio and visual, but also haptic modality, already exist [10], [11] . Most of these solutions use low-cost commercial haptic devices (e.g. joysticks) for therapy training, with the goal of cost minimization and providing procurable technology. Nonetheless, devices specifically developed for stroke rehabilitation, which are already established in clinical settings, may have greater impact on motor relearning and could therefore also be more effective at home, compared with existing home rehabilitation devices.

In a previous paper [12], we presented a concept and design overview of a haptic robot-based telerehabilitation system for upper extremities which is currently under development. In the present work, we describe therapeutic requirements, user-centred development [13] and implementation of the patient’s station of the telesystem.

Continue —> User-centered design of a patient’s work station for haptic robot-based telerehabilitation after stroke : Current Directions in Biomedical Engineering

Figure 3 Implementation of the patient’s work station based on Reha-Slide (left) and Bi-Manu-Track (right).

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