Posts Tagged home-based rehabilitation
[Abstract] Understanding User Requirements for the Design of a Home-Based Stroke Rehabilitation System
Limitations following stroke make it one of the leading causes of disability. The current medical pathway provides intensive care in the acute stages, but rehabilitation services are commonly discontinued after one year. While written home exercise programs are regularly prescribed at the time of discharge, compliancy is an issue. The goal of this study was to inform the design of a home-based portable rehabilitation system based on feedback from individuals with stroke and clinicians. A main component under consideration is the type and format of information feedback provided to the user, as this is hypothesized to support compliance with the rehabilitation program. From a series of focus groups and usability testing, a set of design requirements for the hardware and software were constructed. Essential features mentioned for the feedback interface included: task completion time, quality of movement, a selection of exercises, goal tracking, and a display of historical data.
via Understanding User Requirements for the Design of a Home-Based Stroke Rehabilitation System – Lora A. Cavuoto, Heamchand Subryan, Matthew Stafford, Zhuolin Yang, Sutanuka Bhattacharjya, Wenyao Xu, Jeanne Langan, 2018
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’.
[ARTICLE] Comparison of Two Post-Stroke Rehabilitation Programs: A Follow-Up Study among Primary versus Specialized Health Care – Full Text HTML
To compare home-based rehabilitation (RITH) and standard outpatient rehabilitation in a hospital setting, in terms of improving the functional recovery and quality of life of stroke patients.
Study Design and Setting
This was a prospective cohort study in Andalusia (Spain).
One hundred and forty-five patients completed the outcome data.
Daily activities were measured by the Barthel index, Canadian Neurological Scale (to assess mental state), Tinetti scale (balance and gait), and Short Form Health Survey-36 (SF-36 to compare the quality of life).
No statistically significant differences were found between the two groups regarding the clinical characteristics of patients in the initial measurement, except for age and mental state (younger and with greater neurological impairment in the hospital group). After physical therapy, both groups showed statistically significant improvements from baseline in each of the measures. These improvements were better in RITH patients than in the hospital patients on all functionality scales with a smaller number of sessions.
Home rehabilitation is at least as effective as the outpatient rehabilitation programs in a hospital setting, in terms of recovery of functionality in post-stroke patients. Overall quality of life is severely impaired in both groups, as stroke is a very disabling disease that radically affects patients’ lives.
[Abstract] A Rehabilitation-Internet-of-Things in the Home to Augment Motor Skills and Exercise Training
Although motor learning theory has led to evidence-based practices, few trials have revealed the superiority of one theory-based therapy over another after stroke. Nor have improvements in skills been as clinically robust as one might hope. We review some possible explanations, then potential technology-enabled solutions. Over the Internet, the type, quantity, and quality of practice and exercise in the home and community can be monitored remotely and feedback provided to optimize training frequency, intensity, and progression at home. A theory-driven foundation of synergistic interventions for walking, reaching and grasping, strengthening, and fitness could be provided by a bundle of home-based Rehabilitation Internet-of-Things (RIoT) devices. A RIoT might include wearable, activity-recognition sensors and instrumented rehabilitation devices with radio transmission to a smartphone or tablet to continuously measure repetitions, speed, accuracy, forces, and temporal spatial features of movement. Using telerehabilitation resources, a therapist would interpret the data and provide behavioral training for self-management via goal setting and instruction to increase compliance and long-term carryover. On top of this user-friendly, safe, and conceptually sound foundation to support more opportunity for practice, experimental interventions could be tested or additions and replacements made, perhaps drawing from virtual reality and gaming programs or robots. RIoT devices continuously measure the actual amount of quality practice; improvements and plateaus over time in strength, fitness, and skills; and activity and participation in home and community settings. Investigators may gain more control over some of the confounders of their trials and patients will have access to inexpensive therapies.
[ARTICLE] A survey of home based rehabilitation model performance for movement disorders caused by neurological injuries – Full Text PDF
The aim of this study was to determine the efficacy of home based rehabilitation model performance for movement disorders caused by neurological injuries.
Method: 24 volunteers with movement disorders caused by neurological injuries were included in the study. The participants randomly assigned in one of the two groups, the interventional and the control groups. Intervention program was carried out at home. The average ages of the two groups, interventional and control, were 5.8 and 6.3 years, respectively. Two measurements were applied to determine any alteration in patient improvement: Barthel index was used for measurement of ADL, and EQ-5D (euroqol) was used for quality of life. The assessments for the two groups were carried out twice (pre-tests and posttests). Reassessments were carried out for the two groups at the end of week 5.
Results: Comparison of pre- and post-treatment assessment results of Barthel index in the interventional group indicated a difference in terms of recovery, (P < 0.05). Comparison of pre- and post-treatment assessment results of quality of life in the interventional group indicated a difference in terms of recovery (P < 0.05). The results of the two assessment methods: Barthel index and quality of life, revealed no significant differences between pre and posttests.
Conclusion: The results of this study proved that home based rehabilitation model may enhance the function of the patients and improve the family quality of life.
Full Text PDF
Computerized monitoring of the home based rehabilitation exercise has many benefits and it has attracted considerable interest among the computer vision community. Nowadays, many rehabilitation systems are proposed, most of the targeted disability is for stroke patient. Some of patient or user just wants to take certain part for rehabilitation. Therefore, this paper is focusing on hand rehabilitation system. The importance of the rehabilitation system is to implement the specific exercise for the specific requirements of the patients that needs rehabilitation therapy. This paper presents the specific hand rehabilitation system using computer vision method. The specific hand rehabilitation implemented in this system is a hand deviation exercise. This exercise is benefited to improve the mobility of the hand and reduce the pain. The hand tracking and finger detection method are used in this hand rehabilitation system. The result of the exercise can be used as a training data for the analysis of the injured hand recovery and healing process.
Published on August 26, 2015
Stroke patients affected by an upper-extremity movement dysfunction reported comparatively high levels of effectiveness from constraint-induced movement therapy (CIMT) in improving their daily activities. But in measures of motor function, CIMT fared no better than standard therapy, according to a study published recently in The Lancet Neurology.
The study, led by Anne Barzel, MD, was conducted in Germany and used study subjects from 71 therapy practices in northern Germany. One group of therapy practices was assigned at random to provide 4 weeks of home-based CIMT to study subjects, while another group provided 4 weeks of standard therapy.
Study subjects were qualified for the research based on having mild to moderate impairment of arm function at least 6 months after stroke. Study subjects in both groups received 5 hours of professional therapist contact in 4 weeks, according to a summary published in The Lancet Neurology.
Patients in the standard therapy group received conventional physical or occupational therapy, but additional home training was not obligatory. In the home CIMT group, therapists used the time allotted with the study subjects to instruct and supervise the study subjects as well as their coaches, who were a family member or friend.
According to the summary in The Lancet Neurology, there were two primary outcomes—the first of which was quality of movement, assessed by the Motor Activity Log (MAL-QOM, assessor-assisted self-reported). The second outcome was performance time, assessed by the Wolf Motor Function Test (WMFT-PT, assessor-reported).
Study subjects were assessed at 4 weeks. The researchers reported that study subjects in the home-based CIMT group demonstrated greater improvement than patients in the standard therapy group. The researchers note that while both groups also improved in motor function performance time, the extent of that improvement between the two groups was not significant.
“Home-based CIMT can enhance the perceived use of the stroke-affected arm in daily activities more effectively than conventional therapy but was not superior with respect to motor function,” the authors conclude.
[THESIS] CAHR: A Contextually Adaptive Rehabilitation Framework for In-Home Training – Full Text PDF
Home-based rehabilitation has evolved in recent years as a cost-effective and convenient alternative to traditional clinical rehabilitation. Researchers have developed various types of sensors-based rehabilitation systems that incorporate Virtual Reality games aimed to offer the patient an entertaining and beneficial training experience from the comfort of home. This has consequently created the need to design reliable assessment and adaptation mechanisms that are able to measure and analyze the patient’s performance and condition, and to accordingly make proper adjustments that conform to the abilities of the patient during the training.
In this dissertation, we introduce our context-based adaptive home-based rehabilitation framework (CAHR) that offers the patients a rehabilitation environment that can adapt based on their physical, physiological, and psychological context, while taking into consideration the environmental conditions that may hinder their progress. CAHR is a generic framework that can be implemented to fit any of the upper or lower extremity rehabilitation. However, in this dissertation, we base our modeling and analysis mainly on the wrist.
In CAHR, the physical condition of the patient is assessed by a fuzzy logic-based mechanism that uses the various kinematics captured during the training to provide a quantified value which reflects the Quality of Physical Performance of the patient. The rehabilitation task adaptation is achieved based on a special algorithm that defines how the physical training, psychophysiological responses, and environmental conditions must be manipulated in order to match the desired performance target parameters set by the therapist. The simulation results have shown that the proposed adaptation engine can properly adjust the rehabilitation environment based on different simulated performance behavior that might be produced by a patient. In addition, training with a special game that has been designed based on the developed framework has shown improvement in the physical capabilities of two patients suffering from upper extremity impairments.
[ARTICLE] Patients’ Use of a Home-Based Virtual Reality System to Provide Rehabilitation of the Upper Limb Following Stroke
Background: A low-cost virtual reality system that translates movements of the hand, fingers, and thumb into game play was designed to provide a flexible and motivating approach to increasing adherence to home-based rehabilitation.
Objective: Effectiveness depends on adherence, so did patients use the intervention to the recommended level? If not, what reasons did they give? The purpose of this study was to investigate these and related questions.
Design: A prospective cohort study, plus qualitative analysis of interviews, was conducted.
Methods: Seventeen patients recovering from stroke recruited to the intervention arm of a feasibility trial had the equipment left in their homes for 8 weeks and were advised to use it 3 times a day for periods of no more than 20 minutes. Frequency and duration of use were automatically recorded. At the end of the intervention, participants were interviewed to determine barriers to using it in the recommended way.
Results: Duration of use and how many days they used the equipment are presented for the 13 participants who successfully started the intervention. These figures were highly variable and could fall far short of our recommendations. There was a weak positive correlation between duration and baseline reported activities of daily living. Participants reported lack of familiarity with technology and competing commitments as barriers to use, although they appreciated the flexibility of the intervention and found it motivating.
Limitations: The small sample size limits the conclusions that can be drawn.
Conclusions: Level of use is variable and can fall far short of recommendations. Competing commitments were a barrier to use of the equipment, but participants reported that the intervention was flexible and motivating. It will not suit everyone, but some participants recorded high levels of use. Implications for practice are discussed.
[Proceedings] The ReHAB@HOMe Project: engaging Game-based Home Rehabilitation for Improved quality of Life – Full Text PDF
The REHAB@HOME project is intended as an advanced
activity – with the involvement of highly qualified medical
and technical partners, as well as real patients – aimed at an
extensive investigation of the issues related to long-term
physical/cognitive rehabilitation processes and the
identification of suitable technical solutions to efficiently
support them. REHAB@HOME will enable elderly
people to enjoy high quality rehabilitation for a much
longer period than the Health System can currently afford.
By investigating and using standard hardware components
and devices, suitable medical data processing algorithms,
personalized and serious-games based rehabilitation
pathways, Web2.0 social and communication tools, the
project will develop an efficient, effective and engaging
virtual rehabilitation environment for home-based
rehabilitation. The basic project idea is inspired by
existing commercial platforms, like Wii and Kinect, that
allow the user acting within a virtual environment and
interacting with other users, thanks to special input devices
and suitable technologies able to monitor the real
environment and track the user’s behavior. Having this in
mind, REHAB@HOME aim at the user-centred design
and development of an open solution capable to: provide
exercises and training – based on serious-games – within a
personalized, user friendly and engaging rehabilitation
program, offer a cost effective and not bulky infrastructure
with sensors integrated, collect relevant physical and
medical parameters for patients’ status inspection and
relapse prevention, support off-line/on-line management
and monitoring of the rehabilitation protocol, promote
patient’s social participation and community building. In
other words, REHAB@HOME will transform the
patient’s home in a place where physical and cognitive
rehabilitation process can be performed in an intensive and
engaging though properly controlled way, while
promoting social inclusion and quality of life.