The project was focussing on solutions for patients after a stroke to supply them with a sustainable progress in rehabilitation. The research refers to the upper part of the body, especially the movement of the arms, the grip and the wrists. As medical and technical partners are involved in this project as well as patients, an ongoing rehabilitation process can be evaluated in depth. The project’s aim was to design and develop an open- solution IT-device (concept, hardware/software) that allows the patient to exercise at home to reduce his disabilities. The device offers features and functionalities as a set of exercises based on personalised serious games adapted to the patient’s needs. The challenge on the one side was to develop games which are motivating for the patient and allow him to improve at the same time. The plan is to have the first training with the device during the patient’s stay at the hospital, enabling him to continue his training at home. The games used for a patient are selected individually by the physician and are calibrated to the patient’s needs and abilities, ensuring and optimum degree of exercise.. The player collects rewards as a real-time feedback during his training. As a socialisation component, the patient can also compete with friends or family members.
During the training with this user-friendly IT-device, information about the quality of the performance is provided to the medical personnel. The physical and medical parameters are monitored and evaluated by an on-line/off-line management at the medical centre. The rehabilitation protocol provides a good overview of the patient’s progress to the medical personnel and allows the challenges of the games to be adjusted to the patient’s condition.
The device consists of commercial products like Microsoft KinectTM and using Web2.0 social networks. In this way an effective, efficient and attractive virtual environment for a successful rehabilitation can be built at the patient’s home. Because of the individual handicaps of the game’s users, the challenge was to optimise the games in such way that the training is sufficient for the patient and has enough stimulation to keep the patient exercising. The components themselves are low-cost, robust, good to handle and easy to use. Also, the therapeutic data, physical as well as physiological, are collected via the sensors, and are evaluated with the software developed during the project In this way the medical care can be online as well as off-line. The result of this new kind of service model proposed by Rehab@Home targeting the new technology, coupled with training, demonstration and dissemination will be the integration in the existing public healthcare service.Project Context and Objectives:
In 1997 the number of over-65 year olds constituted 6.6%of the world’s population, and this is predicted to increase to 10% by 2025. It is expected that this will lead to a rise in demand for long-term residential care. Common elderly diseases and ailmentsinclude one or more of the following: arthritis, cancer, cardiovascular (e.g. blood pressure and heart disease), cerebrovascular (e.g. strokes), dementia, depression, diabetes, falls and injuries, gastrointestinal disorders, hearing impairment, memory, osteoporosis, Parkinson’s and Alzheimer’s diseases, respiratory disease, pressure ulcers, sleep problems, thyroid disease, urinary disorders and visual impairment. In many cases, considerable health gain, both from the physical and cognitive perspectives, can be achieved by successful rehabilitation, which is concerned with lessening the impact of specific disabling conditions.
Considering that the aforementioned set of diseases is very broad, to the Rehab@Home project focussed more on one specific indication, stroke. Stroke is the 2nd most common cause of death in Europe (1.24 million annual) and in the European Union (508,000 annual) and the 3rd cause of death in Canada (14,000 annual) and the United States (over 143,000 people each year). Meanwhile, 1.8% of Asians aged 18 years and older have had a stroke. In general, according to the World Health Organization, about 15 million people suffer from stroke worldwide each year. Of these, 5 million die, 10 million survive, though showing different degrees of disabilities. Accordingly, the costs of stroke are enormous. In Europe and the USA, 2-6% of all health care costs are spent on direct stroke care, including the costs of hospital and nursing home care, the services of physicians and other medical professionals, drugs, appliances, and rehabilitation. (Evers S, et. al., “International Comparison of Stroke Cost Studies,” Stroke 35:1209-15, 2004.) Indirect costs, defined as production losses, further increase the burden of the disease. In Europe, direct costs are in the range of 3.000-16.000 Euros per patient during the first year, whereas the lifetime direct cost may reach 30.000 Euros. Taken together, direct and indirect costs may be as high as 20.000-26.000 Euros per patient in the first year. In Europe, 22 billion Euros are spent on stroke annually (Truelsen T, et al., “Cost of stroke in Europe,” Eur. J. Neuro. 12, Suppl 1:78-84, 2005).
Stroke affects everybody differently, and it is difficult to say how much of a recovery is possible. Many stroke survivors experience the most dramatic recovery during their stay in hospital in the weeks after their stroke. But many stroke survivors continue to improve over a longer time, sometimes over a number of years. The goal of rehabilitation is to help survivors become as independent as possible and to attain the best possible quality of life. Rehabilitation does not “cure” stroke in that it does not reverse brain damage. High quality rehabilitation however is essential to regain many – if not all – of their capabilities.
The first stage of rehabilitation usually occurs within an acute-care hospital, as soon as the patient is stable and the (initially high) risk of recurrence is lower. 10% of the survivors can return home quickly, many need to be treated in some type of medical facility. For over half of the of stroke survivors, rehabilitation will be a long-term process requiring work with therapists and specialized equipment for months or (ideally) years after the stroke.
However, increasing cost pressure on the health system will lead to shorter periods of intensive rehabilitation at specialized facilities. Within this context the adoption of suitable technical aids at home, together with a proper training program, can help reducing the patient’s stay at the hospital as well as the need for moving him/her between home and a physiotherapy unit or a paramedical structure.
Rehabilitation, which may be effective in improving the physical and mental condition of older people in long-term care, is a complex set of procedures usually involving several professional disciplines and aimed at improving the quality of life of older people facing daily living difficulties caused by either temporary and/or chronic diseases. Comprehensive rehabilitation needs to address a number of different levels which may be contributing to loss of function: the damaged body part and other related body elements, psychological attitudes, immediate material environment (e.g. clothing items), the surrounding indoor environment (e.g. housing/equipment), external environment (e.g. shops, social outlets), social support networks.
In the specific case of stroke, rehabilitation is based on Neuroplasticity (also known as cortical re-mapping), which is the brain’s ability to reorganize itself by forming new connections, allowing nerve cells in the brain to compensate for defects. However, neuroplasticity is only happening when there is ‘right’ stimulus and sustainable motivation, which are the key factors of successful rehabilitation. Rehabilitation teaches new ways of performing tasks to circumvent or compensate for any residual disabilities. There is a strong consensus among rehabilitation experts that the most important element in any rehabilitation program is carefully directed, well-focused, repetitive practice – the same kind of practice used by all people when they learn any new skill, such as playing guitar or skating.