Archive for category Tele/Home Rehabilitation
Posted by Debbie Overman | Sep 25, 2020
Rehabilitation patients receiving therapy via telehealth methods (videoconference, phone and email) do as well on average, and are just as satisfied, as those getting in-person care, according to a new study from Focus on Therapeutic Outcomes (FOTO), a Net Health company that provides outcomes management software for rehab therapists.
Utilizing telehealth may provide additional benefits, including cost-savings and the ability to reach more patients, the study suggests, according to a media release from Net Health Systems Inc.
FOTO Telehealth Pilot Study
The FOTO Telehealth Pilot Study analyzed over 40,000 episodes-of-care and determined that nearly 4,000 were conducted using telehealth. The degree of telehealth used for each episode was examined across four levels of intensity: 1) any level, 2) less than half of visits, 3) most visits, or 4) all visits. All four levels of telehealth were compared to care delivered by traditional face-to-face interactions.
The researchers found that:
- Telehealth and non-telehealth care episodes were equally effective for improving patients’ functional status.
- Episodes of care involving telehealth had an average of two to three fewer visits, suggesting telehealth may promote greater efficiency of care for the same amount of functional improvement.
- Patients were equally satisfied with their therapy care regardless of whether any care visits were administered using telehealth.
“The research will give rehab therapists peace of mind because they can be confident the care they provide via telehealth is, on average, just as effective as in-person care in improving functional status and achieving high patient satisfaction. They also can promote this information to reach new patients.”
— Net Health CEO Josh Pickus
Improved Access to Care
In addition to helping therapy practices adapt to the pandemic, telehealth expands their reach, enabling therapists to care for elderly and sick people who find in-person visits difficult or impossible, the Net Health release continues.
“Older patients and those with chronic conditions are the largest and fastest-growing patient population being treated by FOTO clinicians. Finding safe and effective alternatives to provide care for older adults is becoming increasingly important.”
— Deanna Hayes, PT, DPT, MS, FOTO Director of Research
Telehealth also helps improve rehab therapy care for people who have reduced access to healthcare, such as those living in remote areas or having limited access to transportation.
Moving Forward with Telehealth
In the release, Net Health suggests that practitioners interested in telehealth begin by incorporating it with traditional on-site clinic care. A telehealth startup playbook could include:
- Phasing in a few telehealth visits for appropriate patient conditions
- Offering telehealth “booster” visits between in-person visits for patients needing more care
- Integrating telehealth with the EHR system to facilitate recordkeeping, efficient billing, HIPAA compliance and reimbursement
FOTO experts will discuss these and other strategies in two upcoming webinars.
The first webinar, “Groundbreaking Telehealth Research Effectiveness Data and its Application to SNFs,” will provide an overview of the study results and impact on skilled nursing facilities on Tuesday, Sept. 29 at 2 p.m. ET.
The second webinar, “Telehealth Effectiveness and Outcomes for Outpatient Rehab Therapy,” will provide an overview of study results for rehab therapists on Thursday, Oct. 1 at 2 p.m. ET.
[Source(s): Net Health Systems Inc, PR Newswire]
[Abstract + References] Virtual and Augmented Reality Platform for Cognitive Tele-Rehabilitation Based System – Conference paper
Virtual and Augmented Reality systems have been increasingly studied, becoming an important complement to traditional therapy as they can provide high-intensity, repetitive and interactive treatments. Several systems have been developed in research projects and some of these have become products mainly for being used at hospitals and care centers. After the initial cognitive rehabilitation performed at rehabilitation centers, patients are obliged to go to the centers, with many consequences, as costs, loss of time, discomfort and demotivation. However, it has been demonstrated that patients recovering at home heal faster because surrounded by the love of their relatives and with the community support.
- 1.Aruanno, B., Garzotto, F., Rodriguez, M.C.: HoloLens-based mixed reality experiences for subjects with alzheimer’s disease. In: Proceedings of the 12th Biannual Conference on Italian SIGCHI Chapter (CHItaly 2017), Article 15, 9 p. (2017)Google Scholar
- 2.Bozgeyikli, L., Raij, A., Katkoori, S., Alqasemi, R.: A survey on virtual reality for individuals with autism spectrum disorder: design considerations. IEEE Trans. Learn. Technol. 11, 133–151 (2018)CrossRefGoogle Scholar
- 3.Cameron, C., et al.: Hand tracking and visualization in a virtual reality simulation, pp. 127–132, April 2011Google Scholar
- 4.American Psychiatric Association Diagnostic: Statistical manual of mental disorders. American psychiatric pub. (2013)Google Scholar
- 5.Gelsomini, M., Garzotto, F., Matarazzo, V., Messina, N., Occhiuto, D.: Creating social stories as wearable hyper-immersive virtual reality experiences for children with neurodevelopmental disorders. In: Proceedings of the 2017 Conference on Interaction Design and Children (IDC 2017), pp. 431–437 (2017)Google Scholar
- 6.Gelsomini, M., Garzotto, F., Montesano, D., Occhiuto, D.: Wildcard: a wearable virtual reality storytelling tool for children with intellectual developmental disability. In: 38th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) Orlando, FL, pp. 5188–5191 (2016)Google Scholar
- 7.Guna, J., Jakus, G., Pogacnik, M., Tomazic, S., Sodnik, J.: An analisis of the precision and reliability of the leap motion sensor and its suitability for static and diynamic tracking. Sensors 14, 3702–3720 (2014)CrossRefGoogle Scholar
- 8.Josman, N., Ben-Chaim, H.M., Friedrich, S., Weiss, P.L.: Effectiveness of virtual reality for teaching street-crossing skills to children and adolescents with autism. Int. J. Disabil. Hum. Dev. 49–56 (2011)Google Scholar
- 9.Aspoc Onlus (2020). http://www.aspoc.it//. Accessed 04 Apr 2020
[Abstract] Motiv’Handed, a New Gamified Approach for Home-Based Hand Rehabilitation for Post-stroke Hemiparetic Patients – Conference paper
This document summarizes a master thesis project trying to bring a new solution to hemiplegia rehabilitation, one of the numerous consequences of strokes. A hemiplegic patients observe paralysis on one side of their body, and as so, loses autonomy and their quality of life decreases. In this study, we decided to only focus on the hand rehabilitation aspect. However, there is a clear tendency in stroke patients to stop training regularly when returning home from the hospital and the first part of their rehabilitation is over. They often experience demotivation, having the feeling that they will never get back to a fully autonomous person ever again and tend to put their training aside, especially when they do not see clear and visible results anymore. This is also due to the supervised training becoming sparser. All of this results in patients stagnating or even worse, regressing. Thus, we decided to offer a motivating solution for hand rehabilitation at home through gamification.
- 1.Stroke Paralysis. Portea. https://www.portea.com/physiotherapy/stroke-paralysis#section_1. Accessed 15 June 2020
- 2.Recovering from Hand Weakness after Stroke. Saebo. https://www.saebo.com/stroke-hand-weakness-recovery/. Accessed 15 June 2020
- 3.UHMA, a new solution for post-stroke home-based hand rehabilitation for patient with hemiparese, Duval–Dachary Sarah, Master thesis (2019)Google Scholar
- 4.Motiv’Handed, a new home-based hand rehabilitation device for post-stroke hemiparetic patients, Chevalier–Lancioni Jean-Philippe, Master Thesis (2020)Google Scholar
- 5.WIM, Jenny Holmsten website. https://www.jennyholmsten.com/wim. Accessed 15 June 2020
- 6.Carneiro, F., Tavares, R., Rodrigues, J., Abreu, P., Restivo, M.: A gamified approach for hand rehabilitation device. Int. J. OnlineGoogle Scholar
- 7.Engineering (iJOE), January 2018. Virtual reality for therapeutic purposes in stroke: A systematic review. S. Viñas-Diza, M. Sobrido-Prieto. s.l. : Elsevier España, S.L.U (2015)Google Scholar
We accept with enthusiasm the call by Jacome et al. published in this issue of Pulmonology.1 Pulmonary rehabilitation may be used for a wide range of purposes and may include decreasing hospital care services, reducing the cost of care, improving adherence to physical activities, training and correcting life styles, improving accessibility, extending services to remote locations, improving self-monitoring, better understanding of prescribed treatments, improving adherence and better communication with health professionals.2
Tele-health has been defined as the use of information and communication technologies to deliver health care services and transmit medical data over long and short distances.3 It encompasses a wide variety of technologies such as videoconferencing, internet platforms, store-and-forward devices, streaming media, and ground and wireless communication. Tele-rehabilitation works to address a basic question: how to improve access to rehabilitation services for patients, in an efficacious, cost-effective, and safe manner? It may provide an ideal opportunity to either improve access to pulmonary rehabilitation (PR) and/or help maintain positive results following a traditional program. Tele-rehabilitation reduces barriers such as insufficient programs and inadequate numbers of qualified health professionals, particularly in rural and regional areas, reduces problems of transportation, accessible parking, as well as walking distance from parking to the hospital. An emerging area of application of technology refers to the use of wearable sensors to facilitate the implementation of home-based rehabilitation interventions. Systems that aim to facilitate the implementation of rehabilitation exercise programs often leverage the combination of sensing technology and interactive gaming or virtual reality (VR) environments.4
Previous studies illustrated the potential of tele-health to facilitate the delivery of PR to patients with chronic obstructive pulmonary disease in their home, as well as to remote settings without the benefits of an established program.5, 6 The Coronavirus (COVID-19) pandemic “day after” is coming and people, who suffered from mild to severe pneumonia up to hypoxemic respiratory failure, might be at risk of long-term impairment and disability.7
Like all patients who have undergone critical illnesses, COVID-19 patients can present dyspnoea and fatigue at rest and during activities of daily living, disability, exercise intolerance, reduction in peripheral muscle function and in nutritional status with significant weight loss. In particular, they may be at risk of residual or worsening parenchymal damage with respiratory muscle function impairment. Furthermore, the infection can negatively affect also other organs like heart, kidneys, muscles and brain, with significant health impacts that may persist. Additionally, people requiring intensive care are at increased risk of post-traumatic stress disorder, anxiety, and depression.8, 9
The newly discovered Coronavirus (COVID-19) and the rigorous request for social distancing has put tele-health (tele-coaching/tele-monitoring/telerehabilitation) in the front line. Tele-rehabilitation may represent the most appropriate response in the post-acute COVID phase by combining need for rehabilitation with need for social distancing.10 It should be adopted in post COVID patients with mild to moderate disabilities, who need frequent monitoring, reside in isolated areas or are not available to participate in standard programs. Our recent experience in this field in a subgroup of post COVID patients (unpublished data) with reduced exercise tolerance, exercise induced desaturation, mild restrictive ventilatory pattern and persistent pathological lung imaging, has given promising results: average adherence to a 30-day program was 88% with improvement in exercise tolerance, dyspnoea and muscle fatigue. Strong monitoring should be maintained through wireless devices and when available wearable technology. Contacts by video-call or phone in order to verify patient adherence to rehabilitation sessions and quality of signals are needed. Despite this preliminary observation, the ideal post COVID candidate, duration of intervention, demonstration of efficacy equivalent to a traditional rehabilitation program to be applied and cost effectiveness are still unknown. Many patients who attend rehabilitation programs are older and may not be using, or have the capacity to use the technology required to delivery tele-rehabilitation. These factors may influence the tele-rehabilitation care environment, and as a consequence, the health outcomes. Patient empowerment and digital health literacy are essential for successful e-Health deployment. Another uncertainty in post COVID patients is the aim that is expected: a substitute for standard programs? purely reinforcement? maintenance program? a modality to improve access? Lack of different modalities of supervision is a crucial point: how to evaluate frequency, intensity, types and timing and how to monitor patients’ adherence remain an unsolved question. Also the time required from staff as well as the amount of data to be interpreted in real time need to be elucidated. Proper training of health professionals and checking the technological requirements, especially in the patient’s home, are also required. Adequate caregiver support may be necessary in cases of residual disability or for technological setting up. Legal problems associated with tele-rehabilitation are still controversial. The patient must be fully aware of the characteristics of the service, the potential risks, the precautions to reduce them and to ensure the confidentiality of the information.11 The associated safety issues are complex and include not only apprehension about malfunctioning equipment, but also concerns regarding potential adverse effects on patient management decisions through delayed or missing information, misunderstood advice, or inaccurate findings.12 Last but not least, the type of equipment used could represent a different per-patient cost, while currently there is insufficient evidence to properly advise about cost-effectiveness. How to perform quality control and modality of reimbursement remains a challenge.
The use of tele-health technology promises to address some major barriers for pulmonary rehabilitation delivery in that it allows for distribution of healthcare services and exchange of information between a healthcare provider and a patient in different geographical locations and therefore can provide an important resource to reach people who live in remote communities or have difficulty accessing traditional centres. National governments should promote common, ethical, legal, regulatory, technical, administrative standards for remote rehabilitation providing safe and effective services. The potential of Tele-rehabilitation has the enticing potential of reducing barriers and improving care. However, much of the research to date has not explored the impact of its introduction at a systems level, incorporating data beyond efficacy in the planning and implementation.
In conclusion we join the international call,1 looking towards wider participation and operative actions.
- 1. Jácome C., Marques A., Oliveira A., Rodrigues L.V., Sanches I. Pulmonary telerehabilitation: an international call for action. Pulmonology. 2020;26 doi: 10.1016/j.pulmoe.2020.05.018. S2531-0437(20)30135-5. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
- 2. Spruit M.A., Singh S.J., Garvey C., ZuWallack R., Nici L., Rochester C. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013;188:e13–64. [PubMed] [Google Scholar]
- 3. Standardization IOf . 2016. ISO Strategy for Services – Case study 1: International SOS (ISO/TS 13131, Telehealth services) [Google Scholar]
- 4. Angelucci A., Aliverti A. Telemonitoring systems for respiratory patients: technological aspects. Pulmonology. 2020;26:221–232. doi: 10.1016/j.pulmoe.2019.11.006. [PubMed] [CrossRef] [Google Scholar]
- 5. Vasilopoulou M., Papaioannou A.I., Kaltsakas G., Louvaris Z., Chynkiamis N., Spetsioti S. Home-based maintenance telerehabilitation reduces the risk for acute exacerbations of COPD, hospitalisations and emergency department visits. Eur Respir J. 2017;49:1602129. [PubMed] [Google Scholar]
- 6. Holland A.E., Mahal A., Hill C.J., Lee A.I., Burge A.T., Cox N.S. Home-based rehabilitation for COPD using minimal resources: a randomised, controlled equivalence trial. Thorax. 2017;72:57–65. doi: 10.1136/thoraxjnl-2016-208514. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
- 7. Vitacca M., Carone M., Clini E.M., Paneroni M., Lazzeri M., Lanza A. Joint statement on the role of respiratory rehabilitation in the COVID-19 crisis: the Italian position paper. Respiration. 2020;99(6):493–499. doi: 10.1159/000508399. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
- 8. Marchioni A., Tonelli R., Sdanganelli A., Gozzi F., Musarò L., Fantini R. Prevalence and development of chronic critical illness in acute patients admitted to a respiratory intensive care setting. Pulmonology. 2020;26:151–158. doi: 10.1016/j.pulmoe.2019.09.006. [PubMed] [CrossRef] [Google Scholar]
- 9. Spagnolo P., Balestro E., Aliberti S., Cocconcelli E., Biondini D., Casa G.D. Pulmonary fibrosis secondary to COVID-19: a call to arms? Lancet Respir Med. 2020;8(8):750–752. [PMC free article] [PubMed] [Google Scholar]
- 10. Vitacca M., Lazzeri M., Guffanti E., Frigerio P., D’Abrosca F., Gianola S. An Italian consensus on pulmonary rehabilitation in COVID-19 patients recovering from acute respiratory failure: results of a Delphi process. Monaldi Arch Chest Dis. 2020;(June):90. doi: 10.4081/monaldi.2020.1444. [PubMed] [CrossRef] [Google Scholar]
- 11. Vitacca M., Paneroni M., Ambrosino N. Pulmonary rehabilitation in post acute patients with Covid-19. In: Donner C.F., Ambrosino N., Goldstein R.S., editors. Pulmonary Rehabilitation. 2nd edition. CRC Press Pub.; 2020. pp. 503–510. [Google Scholar]
- 12. Bauer K.A. The ethical and social dimensions of home-based telemedicine. Crit Rev Biomed Eng. 2000;28:541–544. [PubMed] [Google Scholar]
Telemedicine seemed like a new idea at the outset of the COVID-19 pandemic. However, it now appears to be part of the new norm and might be paving the way to the future.
In a recent review paper published in Telemedicine and e-Health, Brodie Sakakibara, along with the Centre for Chronic Disease Prevention and Management (CCDPM), suggest that virtual appointments, in the form of telerehabilitation, could also work for people recovering from a stroke.
After a stroke, a client is provided with a therapy program to help re-gain loss of skills or motion — this can range from speech and memory, strength, balance and endurance. While not initially introduced for disease outbreaks, Sakakibara, a UBCO assistant professor, suggests that research shows remote therapy can be effective during stroke recovery, a media release from University of British Columbia Okanagan campus notes.
“Telerehabilitation has been promoted as a more efficient means of delivering rehabilitation services to stroke patients while also providing care options to those unable to attend conventional therapy. These services can be provided to remote locations through information and communication technologies and can be accessed by patients in their homes.”
— Brodie Sakakibara
HOW EFFECTIVE IS IT?
To learn how effective telerehabilitation can be, six different clinical trials — examining stroke telerehabilitation programs — were launched across Canada as part of a Heart and Stroke Foundation initiative. People recovering from a stroke were provided with interventions ranging from lifestyle coaching to memory, speech skills and physical-exercise training.
Researchers from each of the six trials came together to write a review paper describing their experiences conducting a telerehabilitation study, and to report on the facilitators and barriers to the implementation of telerehab services within a research context, Sakakibara shares in the release.
Going forward with telerehabilitation as a new reality, Sakakibara says the study authors determined there are important lessons learned from each of the six trials. Most notably, the efficacy and cost of telerehabilitation is similar to that of traditional face-to-face management.
He also notes patients mostly reported satisfaction with the telerehabilitation when therapists were trained appropriately, and when there was some social interaction. Overall, clinicians prefer face-to-face interactions but will use telerehabilitation when face-to-face is not feasible.
And finally, since seniors are a key target group for stroke rehabilitation — as stroke is associated with aging — the technology needs to be easy to use and suit the needs of the end users, the release continues.
“The older adult of today, in terms of technology comfort and use, is different than the older adult of tomorrow. While there might be some hesitation of current older adults using technology to receive health and rehab services, the older adult of tomorrow likely is very comfortable using technology. This represents a large opportunity to develop and establish the telehealth/rehabilitation model of care.”
— Brodie Sakakibara
[Source(s): University of British Columbia Okanagan campus, Science Daily]
• In this article, we presented a newly develop sensor glove as an engaging rehabilitation method for individuals with hand dysfunctions.
• The developed system will enable the therapists to monitor the patient’s progress through the player’s score in the game that is recorded in a progressive log.
• The preliminary results supported that the exercise training using the sensor glove is repetitious, functional, and easy to follow and comply with.
Rehabilitation programs that focus on motor recovery of the upper limb require long-term commitment from the clinicians/therapists, require one-to-one caring, and are usually labor-intensive.
Purpose of the Study
To contribute to this area, we have developed a sensored hand glove integrated with a computer game (Flappy Bird) to engage patients playing a game where the subject’s single/multiple fingers are involved, representing fine motor skill occupational therapeutic exercises.
We described the sensored rehab glove, its hardware design, electrical and electronic design and instrumentation, software design, and pilot testing results.
Experimental results supported that the developed rehab glove system can be effectively used to engage a patient playing a computer game (or a mobile phone game) that can record the data (ie, game score, finger flexion/extension angle, time spent in a therapeutic session, etc.) and put it in a format that could be easily read by a therapist or displayed to the therapists/patients in different graph formats.
We introduced a sensored rehab glove for home-based therapy. The exercise training using the glove is repetitious, functional, and easy to follow and comply with.
Telehealth may not have been at the top of mind before 2020, unless you live in a rural or hard-to-reach location, but these days, many people are facing the new reality of doctor appointments online or by phone. Telehealth isn’t reserved just for talking to your doctor or nurse practitioner about medical issues, though. It can also be part of a rehabilitation program following a serious illness, like a stroke.
In 2004 a group of Italian scientists conducted a study to see if a remote provider using “advanced communication technology” could help rehabilitate stroke patients at home. The study lasted only 4 weeks, but the researchers concluded that “telerehabilitation may represent a new home-based therapy to treated disabled people.”
Sixteen years later, a new study from the University of British Columbia in Canada confirms that telerehabilitation does work for patients recovering from a stroke.
Telerehabilitation Offers Alternatives
“Telerehabilitation has been promoted as a more efficient means of delivering rehabilitation services to stroke patients while also providing care options to those unable to attend conventional therapy,” Brodie Sakakibara, PhD, the paper’s co-author, said in a press release. Dr. Sakakibara is with the Centre for Chronic Disease Prevention and Management (CCDPM).
The study’s data comes from 6 different clinical trials launched across Canada as part of the Heart and Stroke Foundation initiative. People recovering from a stroke were offered interventions from lifestyle coaching to memory, speech skills and physical exercise training. “Researchers from each of the six trials came together to write a review paper describing their experiences conducting a telerehabilitation study, and to report on the facilitators and barriers to the implementation of tele-rehab services withing a research context,” Dr. Sakakibara said.
Each trial provided important tele-rehab lessons, according to Dr. Sakakibara. Among the lessons was that cost and efficacy of tele-rehab is similar to traditional face-to-face programs. Also, patients were most satisfied with tele-rehab when the therapists were well trained and engaged in social interaction. Clinicians, however, preferred face-to-face rehab but used tele-rehab when necessary.
Since strokes are more often associated with older adults, a tele-rehab program’s technology must be easier to use.
“The older adult of today, in terms of technology comfort and use, is different than the older adult of tomorrow,” Dr. Sakakibara said. “While there might be some hesitation of current older adults using technology to receive health and rehab services, the older adult community of tomorrow likely is very comfortable using technology.”
Earlier Studies Had Similar Results
The Canadian study is the latest research validating the use of tele-rehabilitation for stroke patients. In a 2018, 6-week study conducted in 11 American cities with 124 stroke patients, researchers from the University of California at Irvine found that stroke patients using telerehabilitation did just as well as patients receiving face-to-face therapy.
“The current findings support the utility of a computer-based system in the home, used under the supervision of a licensed therapist, to provide clinically meaningful rehab therapy,” Steven C. Cramer, MD, whose research team is part of the National Institutes of Health StrokeNet consortium said in a press release.
Even before the research findings concluded that stroke telerehabilitation works, hospitals and medical systems incorporated it into stroke recovery programs. “Tele-rehabilitation is widely and successfully used to help people recover from stroke and other conditions,” Ana Mond Johnson, CEO of the American Telemedicine Association, wrote in an email to Medical Daily.
The ATA’s Telerehabilitation Special Interest Group includes a wide array of rehabilitation professionals including occupational and physical therapists, speech-language pathologists, rehabilitation physicians and nurses, neuropsychologists, as well as policy experts.
The Pandemic Changed Telehealth’s Profile
In the past 6 months, the COVID-19 pandemic has significantly raised telehealth’s profile. According to a CNBC report, analysts projected 36 million general medical care visits for 2020. Once the pandemic hit that number skyrocketed to 200 million by end of the year.
But telemedicine in all its forms was already carving out its niche in mainstream medicine. According to Medical Economics, at the beginning of 2020 patient adoption of telehealth was up 33% over the previous year. Funding for telehealth is expected to reach $185.6 billion by 2026.
Once these programs are implemented in practice, it will be part of the norm, even when the outbreak is over,” Dr. Sakakibara said. “It is important that we develop and study telerehabilitation programs to ensure the programs are effective and benefit the patients.”
Robert Calandra is an award-winning journalist and book author who has written extensively about health and medicine. His work has appeared in national and regional magazines and newspapers.
By Nilanjana Roy
A study shows the benefits of virtual stroke Of rehabilitation. In a recent review paper by Brodie Sakakibara with the center for chronic disease prevention and management has determined that virtual appointment in the form of telerehabilitation also works for people recovering from a stroke.
After a stroke a client provided with a therapy program to regain the loss of skills or motion this can range from speech and memory, strength, balance, and endurance. Sakakibara a UBCO assistant professor says research shows remote therapy can be effective during stroke recovery. Telerehabilitation has promoted as a more efficient means of delivering rehabilitation services to stroke patients while also providing care options to those who attend conventional therapy.
These services can be provided to remote locations through information and communication technology and can be accessed by the patients from their homes. To learn effective telerehabilitation six different clinical trials have been launched across Canada as a part of the heart and stroke foundation initiated. People who recovered from strokes were given intervention ranging from lifestyle vouching to. Memory speech skills and physical exercise training.
Research for every six trials came together to write a review paper to describe the experience of conducting a telerehabilitation study. And reports on the facilitators and barriers to implementing the telerehabilitation services.
Going with telerehabilitation As a new reality, the study determines there are important lessons to learn from. Each of the six trials. Most importantly the efficiency and cost of telerehabilitation are similar to the face to face management. Patients have mostly reported satisfaction from the telerehabilitation when therapists have trained appropriately and with some social interaction. Clinicians prefer face to face interaction but will use telerehabilitation when face to face is not feasible.
UBCO professor explores future of virtual stroke rehabilitation
Miriam Halpenny – Sep 5, 2020 Photo: Contributed
A new study from UBC Okanagan has revealed the benefits of virtual stroke rehabilitation programs as they may become part of the new normal amid the COVID-19 pandemic.
Virtual medical appointments were considered unconventional when the COVID-19 pandemic initially struck, but they may now be paving the way to the future.
Focused on stroke, a recent review paper by co-author Brodie Sakakibara with the Centre for Chronic Disease Prevention and Management has discovered that virtual appointments also known as telerehabilitation also work.
If someone has a stroke, the patient will be given a therapy program to aid them in regaining loss of motion or skills. This can include speech, memory, strength, balance and endurance.
While not typically used for disease outbreaks, Sakakibara, who is also a UBCO assistant professor, says remote therapy can work for stroke recovery.
“Telerehabilitation has been promoted as a more efficient means of delivering rehabilitation services to stroke patients while also providing care options to those unable to attend conventional therapy,” says Sakakibara.
“These services can be provided to remote locations through information and communication technologies and can be accessed by patients in their homes.”
Six clinical trials focused on stroke telerehabilitation were launched across Canada through a Heart and Stroke Foundation initiative to learn how effective the programs can be.
Through the trials, people who had suffered a stroke were given interventions ranging between lifestyle coaching, memory, speech skills and physical training.
“Researchers from each of the six trials came together to write a review paper describing their experiences conducting a telerehabilitation study, and to report on the facilitators and barriers to the implementation of telerehab services within a research context,” says Sakakibara.
Going forward, important lessons were learned from each of the trials. Particularly, telerehabilitation’s efficacy and cost matches that of traditional in-person management. Sakakibara also says the majority of patients reported satisfaction with the programs when the therapists were trained accordingly and where there was some social interaction.
When it comes to clinicians, they mostly prefer face-to-face interactions but will settle for telerehabilitation when thats not feasible.
Another lesson learned was that because seniors are a main target group for stroke rehabilitation, the technology must be simple and easy to use.
“The older adult of today, in terms of technology comfort and use, is different than the older adult of tomorrow,” says Sakakibara. “While there might be some hesitation of current older adults using technology to receive health and rehab services, the older adult of tomorrow likely is very comfortable using technology. This represents a large opportunity to develop and establish the telehealth/rehabilitation model of care.”
He also notes that the COVID-19 pandemic has amplified the need for telerehabilitation for lots of Canadians, especially ones in remote areas as well as the 70 per cent of stroke victims who can no longer drive.
“Prior to the outbreak, telehealth/rehabilitation was highly recommended in Canadian stroke professional guidelines, but was underused,” he says. “Now in response to COVID-19, the use of telerehabilitation has been accelerated to the forefront. Once these programs are implemented in practice, it’ll be part of the norm, even when the outbreak is over. It is important that we develop and study telerehabilitation programs to ensure the programs are effective and benefit the patients.”
[Conference Paper] HandMATE: Wearable Robotic Hand Exoskeleton and Integrated Android App for At Home Stroke Rehabilitation – Full Text
We have developed HandMATE (Hand Movement Assisting Therapy Exoskeleton); a wearable motorized hand exoskeleton for home-based movement therapy following stroke. Each finger and the thumb is powered by a linear actuator which provides flexion and extension assistance. Force sensitive resistors integrated into the design measure grasp and extension initiation force. An assistive therapy mode is based on an admittance control strategy. We evaluated our control system via subject and bench testing. Errors during a grip force tracking task while using the HandMATE were minimal (<1%) and comparable to unassisted healthy hand performance. We also outline a dedicated app we have developed for optimal use of HandMATE at home. The exoskeleton communicates wirelessly with an Android tablet which features guided exercises, therapeutic games and performance feedback. We surveyed 5 chronic stroke patients who used the HandMATE device to further evaluate our system, receiving positive feedback on the exoskeleton and integrated app.
Stroke is the leading cause of severe long-term disability in the US . The probability of regaining functional use of the impaired upper extremity is low . At 6 months post stroke, 62% of survivors failed to achieve some dexterity . Such impairments can inhibit the individual’s ability to perform activities of daily living (ADL). Subsequently, upper limb rehabilitation recovery to improve ADL is one of the main self-reported goals of stroke survivors .
Outpatient rehabilitation is recommended for survivors that have been discharged from inpatient rehabilitative services . However, outpatient rehabilitation in general is largely underutilized, with only 35.5% of stroke survivors using services . Factors inhibiting outpatient therapy include cost, lack of resources and transportation. Wearable robotics that enable home-based therapy have the potential to overcome these barriers. They provide assistive movement forces which enable task-specific training in real-life situations that patients are often unable to practice without a clinician. See  for wearable hand robots for rehabilitation review.
At home therapy is not without its limitations. The inability to motivate oneself and fatigue are the most common reported factors resulting in failure to adhere to home based exercise programs for stroke recovery . While wearable robotics can reduce fatigue during exercise, it does not directly address lack of motivation. Research has shown incorporating games into home therapy can encourage compliance . Zondervan et al. showed that use of an instrumented sensor glove, named the MusicGlove, improved self-reported use and quality of movement, greater than convention at home exercises . Other studies showed increased motivation to complete the therapeutic exercises and optimized movement when the user is given feedback of their performance via the Microsoft Kinect . Wearable robotic systems that offer feedback and gaming capability may optimize at home stroke therapy.
Such a system was presented by Nijenhuis et al. in which stroke survivors showed motor improvements after completing a 6 week self-administered training program comprised of a dynamic hand orthosis and gaming environment . However, the hand device was passive, assisting only with extension, which limits the range of stroke survivors who could utilize such a system. Research groups have proposed combining their powered take-home wearable hand devices with custom integrated gaming systems , or guided exercises ; however, they have yet to conduct clinical trials. Notably, Ghassemi et al., have developed an integrated multi-user VR system to use with their X-Glove actuated orthosis, which will allow for client-therapist sessions without the patient having to travel .
Tablets are relatively inexpensive, portable, and straight forward to use, with 47% of internet users globally already owning one . Furthermore, a recent study demonstrated the success of a tablet based at home exercise program in improving the recovery of stroke survivors . Notably, the study evaluated the accessibility of tablets, concluding every participant used the tablet successfully. Therefore a wearable powered hand robot with a dedicated tablet app which will provide functional games, task-specific guided exercises and feedback of movement, could optimize at home stroke therapy.
The goal of this project was to create a wearable robotic exoskeleton that enables repetitive practice of task-specific and goal orientated movements, which translates into improvements in ADL. Furthermore, for maximum use and successful integration into home-based rehabilitation, we aimed to create an Android application compatible with the robotic exoskeleton.
To meet these goals, the following design objectives were established: 1) Assistance with finger flex/extension. 2) Assistance with thumb carpometacarpal (CMC) add/abduction and thumb metacarpophalangeal (MCP) flex/extension. 3) Independent assistive control of each finger and thumb. 4) Portable for at home use, meaning the device has to be lightweight and wireless. 5) Relatively affordable. 6) Integrated with android tablet app. Specific design goals for the app included: 1) Easy to use. 2) Allow the user to control the exoskeletons assistance mode through the app. 3) Records the user’s data and prompts the user via notifications to complete the allocated daily or weekly recommended activity time.
In this paper we will evaluate if the proposed device and app goals have been achieved via bench and subject testing.
The HandMATE device (Fig. 1) builds upon the Hand Spring Operated Movement Enhancer (HandSOME) devices , , . The HandSOME devices are non-motorized wearable exoskeletons that assists stroke patients with finger and thumb extension movements. The HandSOME I device assists with gross whole hand opening movements, while the HandSOME II assists isolated extension movement of 15 finger and thumb degrees of freedom (DOF), allowing performance of various grip patterns used in ADL. While both devices have been shown to significantly increase range of motion (ROM) and functional ability in chronic stroke subjects ,, the HandSOME devices only assist with extension movements and require enough flexion activity to overcome the assistance of the extension springs. As many stroke patients also suffer finger and thumb flexion weakness, we decided to build upon the work of the high DOF HandSOME II and additionally utilize power actuation so we can assist with both flexion and extension movements.