Archive for category Tele/Home Rehabilitation

[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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[BLOG POST] Rehabilitation in the Home – Transitions Physiotherapy

Physiotherapy Rehabilitation in the Home

There are two main reasons why physiotherapy rehabilitation in the home has become so popular. The first, is the simple convenience of mobile physiotherapy delivered in the comfort of your own home without having to tackle traffic and parking.The second is because home-based rehabilitation really works!

Rehabilitation takes hard work and requires a lot of practice. The environment around us can affect how easy or difficult it is to practice, practice, practice! Clinic based physiotherapy is important when extra space or specialised equipment is required, and some people prefer to attend a consultation room.

Home-based physiotherapy allows you to take what you have learnt in hospital or clinic and gain real life experience with guidance from an experienced physiotherapist. There are many therapeutic benefits to rehabilitation in the home for people with neurological conditions:

  • Feeling more comfortable in a familiar environment will enhance performance
  • Gain confidence to practice tasks that are the ‘just right challenge’ in your home environment
  • Completing tasks in your own home will have greater meaning so will provide greater motivation
  • Learning tasks in the same place that you will need to practice them will lead to greater practice and repetition
  • Functional tasks such as how to get out of bed or negotiate steps can be tailoredto the exact environment where you need to perform them

Tailoring neurological physiotherapy to real-life is the focus of home visiting physiotherapy.  Rehabilitation in your own home harnesses the principles of neuroplasticity because it can fuel the motivation to continue with the practice of meaningful tasks that are the ‘just right challenge’.

Source: Rehabilitation in the Home – Transitions Physiotherapy Perth

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[Abstract] Telerehabilitation implementation and routine clinical use: Preliminary findings from a case study across three rehabilitation centers

Abstract:

Integrating innovations such as telerehabilitation (TR) into routine clinical care is a complex process. This study aimed to identify the factors which impact on TR implementation and routine use. Methods. A mixed-method prospective single-case study with multiple embedded units of analysis was conducted. Interviews (implementation leaders, clinical champions and upper management) and focus groups with users and non-users of TR were conducted, and TR use was recorded. The Consolidated Framework for Implementation Research and Normalization Process Theory were used to examine factors which impacted on TR implementation and routine use. Results. Over 18 months, 155 TR sessions were carried out by 12 clinicians (6% of potential staff), eight of which continued using TR routinely clinical activities. During implementation, deviations to the intended implementation and unexpected delays impacted on TR use. TR continued to be used for some clinical activities. Facilitators and barriers were related to the intervention, the organisations and the health care context. Discussion. Comprehensive frameworks and theories used in long term studies of TR use can help identify factors which impact on implementation and routine clinical use.

Source: Telerehabilitation implementation and routine clinical use: Preliminary findings from a case study across three rehabilitation centers – IEEE Xplore Document

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[ARTICLE] Domiciliary VR-Based Therapy for Functional Recovery and Cortical Reorganization: Randomized Controlled Trial in Participants at the Chronic Stage Post Stroke – Full Text

ABSTRACT

Background: Most stroke survivors continue to experience motor impairments even after hospital discharge. Virtual reality-based techniques have shown potential for rehabilitative training of these motor impairments. Here we assess the impact of at-home VR-based motor training on functional motor recovery, corticospinal excitability and cortical reorganization.

Objective: The aim of this study was to identify the effects of home-based VR-based motor rehabilitation on (1) cortical reorganization, (2) corticospinal tract, and (3) functional recovery after stroke in comparison to home-based occupational therapy.

Methods: We conducted a parallel-group, controlled trial to compare the effectiveness of domiciliary VR-based therapy with occupational therapy in inducing motor recovery of the upper extremities. A total of 35 participants with chronic stroke underwent 3 weeks of home-based treatment. A group of subjects was trained using a VR-based system for motor rehabilitation, while the control group followed a conventional therapy. Motor function was evaluated at baseline, after the intervention, and at 12-weeks follow-up. In a subgroup of subjects, we used Navigated Brain Stimulation (NBS) procedures to measure the effect of the interventions on corticospinal excitability and cortical reorganization.

Results: Results from the system’s recordings and clinical evaluation showed significantly greater functional recovery for the experimental group when compared with the control group (1.53, SD 2.4 in Chedoke Arm and Hand Activity Inventory). However, functional improvements did not reach clinical significance. After the therapy, physiological measures obtained from a subgroup of subjects revealed an increased corticospinal excitability for distal muscles driven by the pathological hemisphere, that is, abductor pollicis brevis. We also observed a displacement of the centroid of the cortical map for each tested muscle in the damaged hemisphere, which strongly correlated with improvements in clinical scales.

Conclusions: These findings suggest that, in chronic stages, remote delivery of customized VR-based motor training promotes functional gains that are accompanied by neuroplastic changes.

Introduction

After initial hospitalization, many stroke patients return home relatively soon despite still suffering from impairments that require continuous rehabilitation [1]. Therefore, ¼ to ¾ of patients display persistent functional limitations for a period of 3 to 6 months after stroke [2]. Although clinicians may prescribe a home exercise regimen, reports indicate that only one-third of patients actually accomplish it [3]. Consequently, substantial gains in health-related quality of life during inpatient stroke rehabilitation may be followed by equally substantial declines in the 6 months after discharge [4]. Multiple studies have shown, however, that supported discharge combined with at home rehabilitation services does not compromise clinical inpatient outcomes [57] and may enhance recovery in subacute stroke patients [8]. Hence, it is essential that new approaches are deployed that help to manage chronic conditions associated with stroke, including domiciliary interventions [9] and the augmentation of current rehabilitation approaches in order to enhance their efficiency. There should be increased provision of home-based rehabilitation services for community-based adults following stroke, taking cost-effectiveness, and a quick family and social reintegration into account [10].

One of the latest approaches in rehabilitation science is based on the use of robotics and virtual reality (VR), which allow remote delivery of customized treatment by combining dedicated interface devices with automatized training scenarios [1012]. Several studies have tested the acceptability of VR-based setups as an intervention and evaluation tool for rehabilitation [1315]. One example of this technology is the, so called, Rehabilitation Gaming System (RGS) [16], which has been shown to be effective in the rehabilitation of the upper extremities in the acute and the chronic phases of stroke [13]. However, so far little work exists on the quantitative assessment of the clinical impact of VR based approaches and their effects on neural reorganization that can directly inform the design of these systems and their application in the domiciliary context. The main objective of this paper is to further explore the potential and limitations of VR technologies in domiciliary settings. Specifically, we examine the efficacy of a VR-based therapy when used at home for (1) assessing functional improvement, (2) facilitating functional recovery of the upper-limbs, and (3) inducing cortical reorganization. This is the first study testing the effects of VR-based therapy on cortical reorganization and corticospinal integrity using NBS.

Methods

Design

We conducted a parallel-group, controlled trial in order to compare the effectiveness of domiciliary VR-based therapy versus domiciliary occupational therapy (OT) in inducing functional recovery and cortical reorganization in chronic stroke patients.

Participants

Participants were first approached by an occupational therapist from the rehabilitation units of Hospital Esperanza and Hospital Vall d’Hebron from Barcelona to determine their interest in participating in a research project. Recruited participants met the following inclusion criteria: (1) mild-to-moderate upper-limbs hemiparesis (Proximal MRC>2) secondary to a first-ever stroke (>12 months post-stroke), (2) age between 45 and 85 years old, (3) absence of any major cognitive impairment (Mini-Mental State Evaluation, MMSE>22), and (4) previous experience with RGS in the clinic. The ethics committee of clinical research of the Parc de Salut Mar and Vall d’Hebron Research Institute approved the experimental guidelines. Thirty-nine participants at the chronic stage post-stroke were recruited for the study by two occupational therapists, between October 2011 and January 2012, and were assigned to a RGS (n=20) or a control group (n=19) using stratified permuted block randomization methods for balancing the participants’ demographics and clinical scores at baseline (Table 1). One participant in the RGS group refused to participate. Prior to the experiment, participants signed informed consent forms. This trial was not registered at or before the onset of participants’ enrollment because it is a pilot study that evaluates the feasibility of a prototype device. However, this study was registered retrospectively in ClinicalTrials.gov and has the identifier NCT02699398.

Instrumentation

Description of the Rehabilitation Gaming System

The RGS integrates a paradigm of goal-directed action execution and motor imagery [17], allowing the user to control a virtual body (avatar) through an image capture device (Figure 1). For this study, we developed training and evaluation scenarios within the RGS framework. In the Spheroids training scenario (Figure 1), the user has to perform bilateral reaching movements to intercept and grasp a maximum number of spheres moving towards him [16]. RGS captures only joint flexion and extension and filters out the participant’s trunk movements, therefore preventing the execution of compensatory body movements [18]. This task was defined by three difficulty parameters, each of them associated with a specific performance descriptor: (1) different trajectories of the spheres require different ranges of joint motion for elbow and shoulder, (2) the size of the spheres require different hand and grasp precision and perceptual abilities, and (3) the velocity of the spheres require different movement speeds and timing. All these parameters, also including the range of finger flexion and extension required to grasp and release spheroids, were dynamically modulated by the RGS Adaptive Difficulty Controller [19] to maintain the performance ratio (ie, successful trials over the total trials) above 0.6 and below 0.8, optimizing effort and reinforcement during training [20]. […]

Figure 1. Experimental setup and protocol: (A) Movements of the user’s upper limbs are captured and mapped onto an avatar displayed on a screen in first person perspective so that the user sees the movements of the virtual upper extremities. A pair of data gloves equipped with bend sensors captures finger flexion. (B) The Spheroids is divided into three subtasks: hit, grasp, and place. A white separator line divides the workspace in a paretic and non-paretic zone only allowing for ipsilateral movements.(C) The experimental protocol. Evaluation periods (Eval.) indicate clinical evaluations using standard clinical scales and Navigated Brain Stimulation procedures (NBS). These evaluations took place before the first session (W0), after the last session of the treatment (day 15, W3), and at follow-up (week 12, W12).

Continue —>  JSG-Domiciliary VR-Based Therapy for Functional Recovery and Cortical Reorganization: Randomized Controlled Trial in Participants at the Chronic Stage Post Stroke | Ballester | JMIR Serious Games

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[Conference paper] Hand Robotic Rehabilitation: From Hospital to Home – Abstract+References

Abstract

Stroke patients are often affected by hemiparesis. In the rehabilitation of these patients the function of the hand is often neglected. Thus in this work we propose a robotic approach to the rehabilitation of the hand of a stroke patient in hospital and also at home. Some experimental results can be presented here especially for inpatients. Further experimental results on home-patients must be acquired through a telemedicine platform, designed for this application. 

References

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Source: Hand Robotic Rehabilitation: From Hospital to Home | SpringerLink

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[REVIEW] Telerehabilitation: Review of the State-of-the-Art and Areas of Application – Full Text  

ABSTRACT

Background: Telemedicine applications have been increasing due to the development of new computer science technologies and of more advanced telemedical devices. Various types of telerehabilitation treatments and their relative intensities and duration have been reported.

Objective: The objective of this review is to provide a detailed overview of the rehabilitation techniques for remote sites (telerehabilitation) and their fields of application, with analysis of the benefits and the drawbacks related to use. We discuss future applications of telerehabilitation techniques with an emphasis on the development of high-tech devices, and on which new tools and applications can be used in the future.

Methods: We retrieved relevant information and data on telerehabilitation from books, articles and online materials using the Medical Subject Headings (MeSH) “telerehabilitation,” “telemedicine,” and “rehabilitation,” as well as “disabling pathologies.”

Results: Telerehabilitation can be considered as a branch of telemedicine. Although this field is considerably new, its use has rapidly grown in developed countries. In general, telerehabilitation reduces the costs of both health care providers and patients compared with traditional inpatient or person-to-person rehabilitation. Furthermore, patients who live in remote places, where traditional rehabilitation services may not be easily accessible, can benefit from this technology. However, certain disadvantages of telerehabilitation, including skepticism on the part of patients due to remote interaction with their physicians or rehabilitators, should not be underestimated.

Conclusions: This review evaluated different application fields of telerehabilitation, highlighting its benefits and drawbacks. This study may be a starting point for improving approaches and devices for telerehabilitation. In this context, patients’ feedback may be important to adapt rehabilitation techniques and approaches to their needs, which would subsequently help to improve the quality of rehabilitation in the future. The need for proper training and education of people involved in this new and emerging form of intervention for more effective treatment can’t be overstated.

Introduction

In the last few years, telemedicine applications have been increasing due to the development of new computer science technologies and of more advanced telemedical devices. Long-distance communication can be easily achieved by videoconferencing, email, and texting, to name a few. Today there is the possibility of controlling robots, robotic arms, or drones at a distance. Thanks to these advancements, the course of human action has been considerably transformed [1]. During the last 20 years, demographic changes and increased budget allocation in public health have improved new rehabilitative practices [2]. Rehabilitation is an old branch of medicine, but in the last few years, new telecommunication-based practices have been developed all over the world. These particular approaches in the field of rehabilitation are commonly defined as telerehabilitation, which should be considered as a telemedicine subfield consisting of a system to control rehabilitation at a distance [3].

Telerehabilitation has been developed to take care of inpatients, transferring them home after the acute phase of a disease to reduce patient hospitalization times and costs to both patients and health care providers. Telerehabilitation allows for treatment of the acute phase of diseases by substituting the traditional face-to-face approach in the patient-rehabilitator interaction [4]. Finally, it can cover situations in which it is complicated for patients to reach traditional rehabilitation infrastructures located far away from where they live.

Controlled studies on rehabilitation have demonstrated that quick management of an injury or a disease is critical to achieve satisfactory results in terms of increasing a patient’s self-efficacy. Hence, a rehabilitation program should start as soon as possible, be as intensive as possible, be prolonged, and continue during the recovery phase. A major factor is the initiation time, which, in general, should begin as soon as possible. In most cases, the initial stages of rehabilitation, after the occurrence of a disease or injury, could be performed by patients at home even if they need accurate and intensive treatment. For these reasons, telerehabilitation was developed to achieve the same results as would be achieved by the normal rehabilitation process at a hospital or face to face with a physiotherapist. Various types of telerehabilitation treatments and their relative intensities and duration have been reported [5].

The first scientific publication on telerehabilitation is dated 1998 and, in the last few years, the number of articles on the topic has increased, probably because of the emerging needs of people and due to the development of exciting new communication and computer technologies. Figure 1 shows the number of patients treated through telerehabilitation from 1998 to 2008 according to studies published in the international literature [2].

A remarkable increase in the number of patients treated by telerehabilitation is noticeable from 2002 to 2004. After a subsequent decrease, the number of patients assisted by telerehabilitation increased starting from 2007, probably due to the support of new technologies and the overcoming of the initial skepticism to which every new technology is subjected.

Telerehabilitation is primarily applied to physiotherapy [6,7], and neural rehabilitation is used for monitoring the rehabilitative progress of stroke patients [8]. Telerehabilitation techniques mimic virtual reality [912] and rehabilitation for neurological conditions by using robotics and gaming techniques [13]. Quite often, telerehabilitation has been associated with other nonrehabilitative technologies such as remote monitoring of cardiovascular parameters, including electrocardiogram (ECG), blood pressure, and oxygen saturation in patients with chronic diseases [14]. These technologies belong to another telemedicine branch called telemonitoring, which has been widely developed and used in recent years. A few studies were also centered on the economic aspects of the use of telerehabilitation to reduce the costs of hospitalization [15]. We reviewed the status and future perspectives of telerehabilitation by analyzing their impact on patients’ everyday life. The main topics taken into account were (1) the status of telerehabilitation and analysis of the main medical specialties where it is being applied, (2) quality-of-life improvement due to telerehabilitation, and (3) the future of telerehabilitation.

Figure 1. Number of patients treated from 1998 to 2008 through telerehabilitation techniques.

 

Continue —> JRAT-Telerehabilitation: Review of the State-of-the-Art and Areas of Application | Peretti | JMIR Rehabilitation and Assistive Technologies

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[Abstract+References] High-Intensity Chronic Stroke Motor Imagery Neurofeedback Training at Home: Three Case Reports 

Motor imagery (MI) with neurofeedback has been suggested as promising for motor recovery after stroke. Evidence suggests that regular training facilitates compensatory plasticity, but frequent training is difficult to integrate into everyday life. Using a wireless electroencephalogram (EEG) system, we implemented a frequent and efficient neurofeedback training at the patients’ home. Aiming to overcome maladaptive changes in cortical lateralization patterns we presented a visual feedback, representing the degree of contralateral sensorimotor cortical activity and the degree of sensorimotor cortex lateralization. Three stroke patients practiced every other day, over a period of 4 weeks. Training-related changes were evaluated on behavioral, functional, and structural levels. All 3 patients indicated that they enjoyed the training and were highly motivated throughout the entire training regime. EEG activity induced by MI of the affected hand became more lateralized over the course of training in all three patients. The patient with a significant functional change also showed increased white matter integrity as revealed by diffusion tensor imaging, and a substantial clinical improvement of upper limb motor functions. Our study provides evidence that regular, home-based practice of MI neurofeedback has the potential to facilitate cortical reorganization and may also increase associated improvements of upper limb motor function in chronic stroke patients.

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Source: High-Intensity Chronic Stroke Motor Imagery Neurofeedback Training at Home: Three Case ReportsClinical EEG and Neuroscience – Catharina Zich, Stefan Debener, Clara Schweinitz, Annette Sterr, Joost Meekes, Cornelia Kranczioch, 2017

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[ARTICLE] Home-based neurologic music therapy for arm hemiparesis following stroke: results from a pilot, feasibility randomized controlled trial – Full Text

 

Continue —> Home-based neurologic music therapy for arm hemiparesis following stroke: results from a pilot, feasibility randomized controlled trialClinical Rehabilitation – Alexander J Street, Wendy L Magee, Andrew Bateman, Michael Parker, Helen Odell-Miller, Jorg Fachner, 2017

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Figure 1. Study flow diagram. Data collection occurred at weeks 1, 6, 9, 15 and 18. Cross-over analysis required data from weeks 1, 6, 9 and 15.

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[Editorial] E-Rehabilitation: New Reality or Virtual Need?

 

This is an era of digitalization, internet, wifi, use of mobile and smart phones, virtual world, applications and technology. On one hand these are contributing to cyber psychopathology, on the other hand these have a potential for management.

With the understanding of disability as a complex interaction between the effects of illness and contextual factors, both personal and environmental, the relevance of new avenues to deliver rehabilitative services is profound. A significant proportion of the population is underserved, with the National Mental Health Survey of India 2016- a survey which covered 34,802 individuals from 12 states of India- showing a mental morbidity of 10.6% in those over the age of 18 years, and 7.3% in those between the ages of 13 and 17, but with a treatment gap of 28–83% (and 86% for alcohol use disorders). In addition, “three out of four persons with a severe mental disorder experienced significant disability in work, social and family life” [1]. Given the extent of the need and the dearth of services, the report recommends the following, “Technology based applications for near-to-home-based care using smart-phone by health workers, evidence-based (electronic) clinical decision support systems for adopting minimum levels of care by doctors, creating systems for longitudinal follow-up of affected persons to ensure continued care through electronic databases and registers can greatly help in this direction. To facilitate this, convergence with other flagship schemes such as Digital India needs to be explored” [1]. Recent data has shown that smartphone user base in India has crossed 300 million users in 2016, making it the second largest smartphone market in the world [2]. The potential for service delivery via internet enabled devices seems likely only to rise over time, but what are the possibilities before us now, and equally important, what are the challenges to such approaches?

An exploration of the role of modern technology in rehabilitation in January, 2016, has highlighted the various possibilities in terms of social networking and peer support, telepsychiatry, E health services as well as smartphones and apps [3]. It’s interesting that estimates at the time alluded to smartphone users crossing the 200 million mark in 2016, a 100 million users less than later estimates! Looking ahead these are the ways new and emerging technologies could change the ways we approach and conceptualise recovery,

  1. (a)

    Information access: Access to information and more specifically, access to relevant and accurate information have to potential to allow caregivers and patients to recognise mental health issues early, and seek help. Some of this information will be from traditional media, such as radio and television, but a significant proportion of people are likely to glean this information from social media sites and communication apps—such as the almost ubiquitous Whatsapp—on which they also consume other services and obtain their daily news and information from. Search algorithms and the way they rank different sources of information are likely to play an important role in the way people form their opinions about the illnesses they suffer from and the way they seek help. There is a need for curated information on mental health, especially in the Indian context and in vernacular languages, that people can not only refer to themselves, but which they can direct their friends and family toward as reliable sources of information too. Health care professionals must be prepared to help their patients learn ‘eHealth literacy’ [4].

  2. (b)

    Automation: Work is something that most people with mental illness aspire to do, and this can enhance their quality of life significantly [5]. Automation and applications of artificial intelligence are poised to change the face of industry as well as our lifestyles. Some traditional jobs such as fabrication and driving are poised to radically change. This will mean that vocational rehabilitation programmes will have to keep pace with a changing environment, and look to integrating industry expertise in the designing of courses and course materials which remain relevant to patients. Government programmes such as the Skill India initiative have the potential to help evolve this flexibility in course design, and to skill or re-skill persons in their quest to obtain and sustain jobs.

    Workplace is being replaced by home based workstations, computers, laptops and notebooks. People accustomed to these run their office from anywhere and everywhere. There will be a need to redefine ‘work place’ as ‘where ever the laptop is’. Thus, in future, persons undergoing rehabilitation, can ‘work from home’, provided they have the facilities, and job to do. Staying and working from home for persons with mental health problems, will prevent them from ‘live’ socialising, using social skills, and giving respite to family caregivers. On the other hand, they would be under direct supervision of the family, reducing their concerns and anxieties.

  3. (c)

    Digital identities and digital payments: With the increasing digitisation of access to services, there is a growing need for education in digital literacy and security. Programmes which teach life skills will have to help their users familiarise themselves with the advantages of new technologies as well as the risks they bring. A number of records related to disability are likely to form parts of central databases, such as the Unique Disability ID [6], and the potential to offer a number of services through a single user interface to those with disability is significant. It would also ease the accessing of such benefits even when patients travel or move to other states, whether temporarily or permanently. The storage of health records in electronic formats, e-health records, would allow patients to exert control over access to their own records and enable transfers from one healthcare provider to another without delay or loss of information. An e-health record format which is shared among different providers and which allows different hospital information systems to effectively share information is an important need. There can be a possibility to maintain a central registry of persons receiving mental health rehabilitation services.

  4. (d)

    Wearables and digital phenotyping: The mobile devices and other wearable accessories we use have the potential to collect vast amounts of information about our health. Newer approaches look to collect information such as changes in the speed of our typing or motor movements, or the searches we repeat and use these to make estimates about the status of our cognitive and neurological health in real time–an approach called digital phenotyping. This could aid in monitoring persons suffering from dementia or mild cognitive deficits. It could also be used to explore trajectories of development in children and adolescents, and could help inform early intervention programmes. Over and above monitoring, the use of digital assistants could be used to guide and shape behaviour in real time, provide cognitive aids and reduce dependency as well as the burden on caregivers for some tasks.

  5. (e)

    Virtual Reality and Augmented reality: Virtual reality (VR) refers to an interactive immersive experience wherein a computer generated world which a user can interact with is simulated with either a screen or a heads-up display. Augmented reality systems allow perception of the environment around along with the simulated projection. It’s also used to refer to situations where mobile phones or wearables can be used to interact with the environment around to either generate a virtual experience or provide additional information.

    It’s been used as an application for interventions in phobias for some time. Recent gains in the technology have coincided with an expansion of uses to cognitive rehabilitation, social skills training and even craving management in alcohol use disorders [7]. The number of mental health professionals available to deliver these services is low compared to demand and unequally distributed. With the evolution of mobile systems that can deliver VR experiences, such as the Google Daydream platform, it may be possible to translate some of these packages into content that can be delivered across such platforms with fidelity. There is still some work to be done about how perception of such experiences can affect symptoms in those with mental illness, and even if the same visual illusions are perceived differently.

  6. (f)

    Social networks, communication apps and peer support: Social networks and social media increasingly influence information access and viewpoints. They can serve as accepting communities to which people can feel as if they belong. They can also carry risks, including the spread of myths and misconceptions. Peer support groups, much like other networks, are now easier to form and to find. Hence, the potential for persons with mental illness to be involved in advocacy movements and to influence public policy is unprecedented, if still underutilised. The ability to use social networks and the internet to market products and expand networks can help those who chose to be entrepreneurs have greater reach and exposure. The ability to use these networks effectively, and other marketing skills, would also become a skill set that requires mentoring in.

  7. (g)

    The use of learning networks: Virtual classrooms and virtual learning networks have the potential to raise standards of care delivery by spreading best care practices and knowledge. Initiatives like the ECHO network and the Virtual Knowledge Network, NIMHANS can help spread the expertise of institutes by mentoring professionals who are involved in care delivery. They can also serve as ways to allow different institutes to demonstrate their own best practices and innovative models of service delivery to their peers.

The future of psychiatric practice, including psychiatric rehabilitation, in relation to virtual reality, technology and gadgets is likely to change with advances in technology and their usage [8]. While the tools that are available are changing, they will still be guided by the principles that form the bedrock of good practice in rehabilitation. Patients and their families may be drawn to online resources for rehabilitation.

The current issue of the journal is rather healthy with seventeen articles. And there is a good global distribution as well, with descriptions of mental health and rehabilitation services in Vietnam, Nigeria, USA, UK, Canada, Malaysia, and Iran. These have also covered a wide range of themes, from recovery scales, models for community based rehabilitation and community participation, in patient services, first episode psychosis, helping mothers with intellectual disabilities, and infertility. In addition, a book review on a very useful book on challenges of care giving for mental illness, cover an interesting spectrum of articles.

Source: E-Rehabilitation: New Reality or Virtual Need? | SpringerLink

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