Posts Tagged home-based

[Abstract] Efficacy of Home-Based Telerehabilitation vs In-Clinic Therapy for Adults After Stroke: A Randomized Clinical Trial.

Abstract

IMPORTANCE:

Many patients receive suboptimal rehabilitation therapy doses after stroke owing to limited access to therapists and difficulty with transportation, and their knowledge about stroke is often limited. Telehealth can potentially address these issues.

OBJECTIVES:

To determine whether treatment targeting arm movement delivered via a home-based telerehabilitation (TR) system has comparable efficacy with dose-matched, intensity-matched therapy delivered in a traditional in-clinic (IC) setting, and to examine whether this system has comparable efficacy for providing stroke education.

DESIGN, SETTING, AND PARTICIPANTS:

In this randomized, assessor-blinded, noninferiority trial across 11 US sites, 124 patients who had experienced stroke 4 to 36 weeks prior and had arm motor deficits (Fugl-Meyer [FM] score, 22-56 of 66) were enrolled between September 18, 2015, and December 28, 2017, to receive telerehabilitation therapy in the home (TR group) or therapy at an outpatient rehabilitation therapy clinic (IC group). Primary efficacy analysis used the intent-to-treat population.

INTERVENTIONS:

Participants received 36 sessions (70 minutes each) of arm motor therapy plus stroke education, with therapy intensity, duration, and frequency matched across groups.

MAIN OUTCOMES AND MEASURES:

Change in FM score from baseline to 4 weeks after end of therapy and change in stroke knowledge from baseline to end of therapy.

RESULTS:

A total of 124 participants (34 women and 90 men) had a mean (SD) age of 61 (14) years, a mean (SD) baseline FM score of 43 (8) points, and were enrolled a mean (SD) of 18.7 (8.9) weeks after experiencing a stroke. Among those treated, patients in the IC group were adherent to 33.6 of the 36 therapy sessions (93.3%) and patients in the TR group were adherent to 35.4 of the 36 assigned therapy sessions (98.3%). Patients in the IC group had a mean (SD) FM score change of 8.36 (7.04) points from baseline to 30 days after therapy (P < .001), while those in the TR group had a mean (SD) change of 7.86 (6.68) points (P < .001). The covariate-adjusted mean FM score change was 0.06 (95% CI, -2.14 to 2.26) points higher in the TR group (P = .96). The noninferiority margin was 2.47 and fell outside the 95% CI, indicating that TR is not inferior to IC therapy. Motor gains remained significant when patients enrolled early (<90 days) or late (≥90 days) after stroke were examined separately.

CONCLUSIONS AND RELEVANCE:

Activity-based training produced substantial gains in arm motor function regardless of whether it was provided via home-based telerehabilitation or traditional in-clinic rehabilitation. The findings of this study suggest that telerehabilitation has the potential to substantially increase access to rehabilitation therapy on a large scale.

 

via Efficacy of Home-Based Telerehabilitation vs In-Clinic Therapy for Adults After Stroke: A Randomized Clinical Trial. – PubMed – NCBI

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[ARTICLE] Factors influencing the implementation of Home-Based Stroke Rehabilitation: Professionals’ perspective – Full Text

Abstract

Background

Stroke has a major impact on survivors and their social environment. Care delivery is advocated to become more client-centered and home-based because of their positive impact on client outcomes. The objective of this study was to explore professionals’ perspectives on the provision of Home-Based Stroke Rehabilitation (HBSR) in the Netherlands and on the barriers and facilitators influencing the implementation of HBSR in daily practice.

Methods

Semi-structured focus groups were conducted to explore the perspectives of health and social care professionals involved in stroke rehabilitation. Directed content analysis was performed to analyze the transcripts of recorded conversations.

Results

Fourteen professionals participated in focus groups (n = 12) or, if unable to attend, an interview (n = 2). Participants varied in professional backgrounds and roles in treating Dutch clients post stroke. Barriers and facilitators influencing the implementation of HBSR in daily practice were identified in relation to: the innovation, the user, the organization and the socio-political context. Participants reported that HBSR can be efficient and effective to most clients because it facilitates client- and caregiver-centered rehabilitation within the clients’ own environment. However, barriers in implementing HBSR were perceived in a lack of (structured) inter-professional collaboration and the transparency of expertise of primary care professionals. Also, the current financial structures for HBSR in the Netherlands are viewed as inappropriate.

Discussion

In line with previous studies, we found that HBSR is recognized by professionals as a promising alternative to institution-based rehabilitation for clients with sufficient capabilities (e.g. their own health and informal support).

Conclusion

Multiple factors influencing the implementation of HBSR were identified. Our study suggests that, in order to implement HBSR in daily practice, region specific implementation strategies need to be developed. We recommend developing strategies concerning: organized and coordinated inter-professional collaboration, transparency of the expertise of primary care professionals, and the financial structures of HBSR.

 

Introduction

Stroke is one of the major causes of mortality, loss of independence, and lower quality of life of stroke survivors and has a great impact on the social environment [1]. Between 2010 and 2030 the absolute number of people with a stroke is expected to increase by 56% in men and 37% in women [2]. Also, stroke is known to have major socio-economic consequences. The financial burden placed on European countries by stroke is huge. For 2010, the estimated cost of stroke in Europe was €64 billion [3].

Stroke rehabilitation in the Netherlands

In the Netherlands, stroke rehabilitation is organized and delivered in various ways. From the late ‘90, three main types of stroke rehabilitation can be distinguished in the Netherlands.

Firstly, stroke rehabilitation can be offered as institution-based rehabilitation: organized within hospitals, rehabilitation centers and nursing homes. Within institution-based rehabilitation, care is centered around a diagnosis. Professionals are specialized in treating clients with this specific diagnosis. Also, within the institution, regular (formal and informal) inter-professional meetings take place [4].

Secondly, stroke rehabilitation can be offered on outpatient basis. After their transfer home (from the stroke unit or institution-based rehabilitation), stroke survivors can consult outpatient rehabilitation professionals. Stroke survivors receiving outpatient rehabilitation live at home and visit the institution to receive therapy.

Thirdly, stroke rehabilitation can be offered as Home-Based Stroke Rehabilitation (HBSR). During HBSR (Home-Based Stroke Rehabilitation) rehabilitation is offered within the home environment of the client. It includes community-based rehabilitation delivered by primary care professionals, such as occupational therapists, physical therapists, speech therapists, dieticians, social workers, nurses and general practitioners [5]. A broad range of professionals can be involved during HBSR, because the impact of stroke is multifaceted, affecting a broad range of body functions, activities and participation patterns [6]. In the Netherlands primary care is not nationally organized: professionals deliver care from independent private practices and from a variety of institutions. General health insurances cover a certain (predefined) amount of treatment hours for selected disciplines only. The variety in financial legislations between these selected disciplines is large. Sometimes additional treatment hours and/or disciplines are financed, depending on the severity of symptoms, personal circumstances and insurance coverage. Insurance coverage differs per person and depends on the selection of optional insurances.

Home-Based Stroke Rehabilitation (HBSR)

Healthcare professionals and organizations are challenged to provide high quality health and social care, in a client centered and cost-efficient manner. To improve the quality and efficiency of care, the location of care delivery is shifting from institution-based settings to home-based services such as HBSR.

HBSR is known for its positive impact on client outcomes. HBSR resulted in more independent clients [78] who are better at performing daily activities [89] and who are more satisfied with their treatment compared to clients who receive conventional (institution-based) rehabilitation [812]. Also, HBSR is shown to reduce the length of hospital stay and to decrease the likelihood of admittance in a long-term stay facility [8]. Furthermore, HBSR has the benefit of treating clients within a familiar environment. According to prior studies this tends to stimulate mental and physical activity, provides more meaning to tasks [1314] and prevents potential problems with the transfer of learned skills from the training setting to executing daily activities [15].

Implementing HBSR

In the Netherlands a number of reforms and new policies have been implemented over the last years to facilitate client-centered and cost-effective care. These changes include policies increasing the responsibility of the municipalities for care and welfare on the municipality and transferring more responsibilities from professional carers to civilians and local communities themselves [16]. Despite these efforts, the client-centered and cost-effective provision of high quality care remains a challenge because guidelines, practical suggestions and organisational support seems to be missing [17]. Consequently, both researchers as well as healthcare professionals initiate new regional projects [1719]. According to the literature, this does not only take place in the Netherlands. Many clients do not receive appropriate care, or receive unnecessary or even harmful care [20].

Major difficulties can arise when implementing innovations, like HBSR, into routine practice. Even though previous studies have shown positive effects of HBSR [715], innovations are not always provided to those clients for whom it could be beneficial [21]. Prior studies show that clients and caregivers experience a gap after institution-based rehabilitation (e.g. delays and discontinuity of therapy and feeling abandoned and unsupported) and poor accessibility of community services [2223]. In order to further implement an innovation like HBSR, context specific implementation strategies are needed at different levels [2426].

This Dutch study explores and describes professionals’ perspectives on determinants that could influence the further implementation of HBSR. These insights can guide the selection of context specific implementation strategies. This study will not only provide insight into region specific factors influencing implementation, but also general issues playing a role in the implementation of HBSR.

In this qualitative focus group study we focused on the following questions:

  1. How do professionals characterize stroke rehabilitation services that are currently provided in the Netherlands?
  2. What are the current and potential barriers and facilitators influencing the implementation of HBSR in their daily practice, according to professionals?
[…]

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[ARTICLE] Factors influencing the implementation of Home-Based Stroke Rehabilitation: Professionals’ perspective – Full Text

Abstract

Background

Stroke has a major impact on survivors and their social environment. Care delivery is advocated to become more client-centered and home-based because of their positive impact on client outcomes. The objective of this study was to explore professionals’ perspectives on the provision of Home-Based Stroke Rehabilitation (HBSR) in the Netherlands and on the barriers and facilitators influencing the implementation of HBSR in daily practice.

Methods

Semi-structured focus groups were conducted to explore the perspectives of health and social care professionals involved in stroke rehabilitation. Directed content analysis was performed to analyze the transcripts of recorded conversations.

Results

Fourteen professionals participated in focus groups (n = 12) or, if unable to attend, an interview (n = 2). Participants varied in professional backgrounds and roles in treating Dutch clients post stroke. Barriers and facilitators influencing the implementation of HBSR in daily practice were identified in relation to: the innovation, the user, the organization and the socio-political context. Participants reported that HBSR can be efficient and effective to most clients because it facilitates client- and caregiver-centered rehabilitation within the clients’ own environment. However, barriers in implementing HBSR were perceived in a lack of (structured) inter-professional collaboration and the transparency of expertise of primary care professionals. Also, the current financial structures for HBSR in the Netherlands are viewed as inappropriate.

Discussion

In line with previous studies, we found that HBSR is recognized by professionals as a promising alternative to institution-based rehabilitation for clients with sufficient capabilities (e.g. their own health and informal support).

Conclusion

Multiple factors influencing the implementation of HBSR were identified. Our study suggests that, in order to implement HBSR in daily practice, region specific implementation strategies need to be developed. We recommend developing strategies concerning: organized and coordinated inter-professional collaboration, transparency of the expertise of primary care professionals, and the financial structures of HBSR.

Introduction

Stroke is one of the major causes of mortality, loss of independence, and lower quality of life of stroke survivors and has a great impact on the social environment [1]. Between 2010 and 2030 the absolute number of people with a stroke is expected to increase by 56% in men and 37% in women [2]. Also, stroke is known to have major socio-economic consequences. The financial burden placed on European countries by stroke is huge. For 2010, the estimated cost of stroke in Europe was €64 billion [3].

Stroke rehabilitation in the Netherlands

In the Netherlands, stroke rehabilitation is organized and delivered in various ways. From the late ‘90, three main types of stroke rehabilitation can be distinguished in the Netherlands.

Firstly, stroke rehabilitation can be offered as institution-based rehabilitation: organized within hospitals, rehabilitation centers and nursing homes. Within institution-based rehabilitation, care is centered around a diagnosis. Professionals are specialized in treating clients with this specific diagnosis. Also, within the institution, regular (formal and informal) inter-professional meetings take place [4].

Secondly, stroke rehabilitation can be offered on outpatient basis. After their transfer home (from the stroke unit or institution-based rehabilitation), stroke survivors can consult outpatient rehabilitation professionals. Stroke survivors receiving outpatient rehabilitation live at home and visit the institution to receive therapy.

Thirdly, stroke rehabilitation can be offered as Home-Based Stroke Rehabilitation (HBSR). During HBSR (Home-Based Stroke Rehabilitation) rehabilitation is offered within the home environment of the client. It includes community-based rehabilitation delivered by primary care professionals, such as occupational therapists, physical therapists, speech therapists, dieticians, social workers, nurses and general practitioners [5]. A broad range of professionals can be involved during HBSR, because the impact of stroke is multifaceted, affecting a broad range of body functions, activities and participation patterns [6]. In the Netherlands primary care is not nationally organized: professionals deliver care from independent private practices and from a variety of institutions. General health insurances cover a certain (predefined) amount of treatment hours for selected disciplines only. The variety in financial legislations between these selected disciplines is large. Sometimes additional treatment hours and/or disciplines are financed, depending on the severity of symptoms, personal circumstances and insurance coverage. Insurance coverage differs per person and depends on the selection of optional insurances.

Home-Based Stroke Rehabilitation (HBSR)

Healthcare professionals and organizations are challenged to provide high quality health and social care, in a client centered and cost-efficient manner. To improve the quality and efficiency of care, the location of care delivery is shifting from institution-based settings to home-based services such as HBSR.

HBSR is known for its positive impact on client outcomes. HBSR resulted in more independent clients [78] who are better at performing daily activities [89] and who are more satisfied with their treatment compared to clients who receive conventional (institution-based) rehabilitation [812]. Also, HBSR is shown to reduce the length of hospital stay and to decrease the likelihood of admittance in a long-term stay facility [8]. Furthermore, HBSR has the benefit of treating clients within a familiar environment. According to prior studies this tends to stimulate mental and physical activity, provides more meaning to tasks [1314] and prevents potential problems with the transfer of learned skills from the training setting to executing daily activities [15].

Implementing HBSR

In the Netherlands a number of reforms and new policies have been implemented over the last years to facilitate client-centered and cost-effective care. These changes include policies increasing the responsibility of the municipalities for care and welfare on the municipality and transferring more responsibilities from professional carers to civilians and local communities themselves [16]. Despite these efforts, the client-centered and cost-effective provision of high quality care remains a challenge because guidelines, practical suggestions and organisational support seems to be missing [17]. Consequently, both researchers as well as healthcare professionals initiate new regional projects [1719]. According to the literature, this does not only take place in the Netherlands. Many clients do not receive appropriate care, or receive unnecessary or even harmful care [20].

Major difficulties can arise when implementing innovations, like HBSR, into routine practice. Even though previous studies have shown positive effects of HBSR [715], innovations are not always provided to those clients for whom it could be beneficial [21]. Prior studies show that clients and caregivers experience a gap after institution-based rehabilitation (e.g. delays and discontinuity of therapy and feeling abandoned and unsupported) and poor accessibility of community services [2223]. In order to further implement an innovation like HBSR, context specific implementation strategies are needed at different levels [2426].

This Dutch study explores and describes professionals’ perspectives on determinants that could influence the further implementation of HBSR. These insights can guide the selection of context specific implementation strategies. This study will not only provide insight into region specific factors influencing implementation, but also general issues playing a role in the implementation of HBSR.

In this qualitative focus group study we focused on the following questions:

  1. How do professionals characterize stroke rehabilitation services that are currently provided in the Netherlands?
  2. What are the current and potential barriers and facilitators influencing the implementation of HBSR in their daily practice, according to professionals?

[…]

 

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[Abstract + References] A Preliminary Analysis of a Home-Based Stroke Rehabilitation Program in Windsor, Ontario

Abstract

Community stroke rehabilitation (CSR) is an effective program for survivors to recover at home supported by a multidisciplinary team. A home-based, specialized CSR program was delivered in Windsor, Ontario, to stroke patients who faced barriers to accessing outpatient services following inpatient rehabilitation. Preliminary results show program patients made significant functional improvements from baseline to program discharge. A subgroup analysis revealed that, after adjusting for age and resource intensity, moderate to severe stroke patients made greater functional gains compared to mild stroke patients. The individualized focus of CSR delivered in the home provides an effective model of rehabilitation for continued stroke care in the community.

References 

1. Hebert, D, Lindsay, MP, McIntyre, A, et al. Canadian stroke best practice recommendations: stroke rehabilitation practice guidelines, update 2015. Int J Stroke. 2016;11:459–84.CrossRef | Google Scholar | PubMed

2. Langstaff, C, Martin, C, Brown, G, et al. Enhancing community-based rehabilitation for stroke survivors: creating a discharge link. Top Stroke Rehabil. 2014;21:510–9.CrossRef | Google Scholar | PubMed

3. Passalent, LA, Landry, MD, Cott, CA. Wait times for publically funded outpatient and community physiotherapy and occupational therapy services: implications for the increasing number of persons with chronic conditions in Ontario, Canada. Physiother Can. 2009;61:5–14.CrossRef | Google Scholar

4. Pereira, S, Foley, N, Salter, K, et al. Discharge destination of individuals with severe stroke undergoing rehabilitation: a predicative model. Disabil Rehabil. 2014;36(6):727–31.CrossRef | Google Scholar

5. Pereira, S, Ross Graham, J, Shahabaz, A, et al. Rehablitation of individuals with severe stroke: Synthesis of best evidence and challenges in implementation. Topics Stroke Rehabil. 2012;19:122–31.CrossRef | Google Scholar

6. Windsor Essex County Health Unit. Community needs assessment report. Windsor, Ontario; 2016.Google Scholar

7. Hall, RE, Kahn, F, Levi, J, et al. Ontario and LHIN 2015/2016 stroke report cards and progress reports: setting the bar higher. Toronto, ON: Institute for Clinical Evaluative Science; 2017.Google Scholar

8. Allen, L, Richardson, A, McIntyre, S, et al. Community stroke rehabilitation teams: providing home-based stroke rehabilitation in Ontario, Canada. Can J Neurol Sci. 2014;41:697–703.Google Scholar | PubMed

9. Allen, L, McIntyre, A, Janzen, S, et al. Community stroke rehabilitation: how do rural residents fare compared with their urban counterparts? Can J Neurol Sci. 2016;43:98–104.CrossRef | Google Scholar | PubMed

10. Canadian Institute for Health Information. Pathways of care for people with stroke in Ontario; 2012. Available at: https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC1695.Google Scholar

11. Keith, RA, Granger, CV, Hamilton, BB, et al. The functional independence measure: a new tool for rehabilitation. Adv Clin Rehabil. 1987;1:6–18.Google Scholar | PubMed

12. Teasell, R, Hussein, N, Foley, N. Evidence-based review of stroke rehabilitation (EBRSR), 18th ed. London, ON; EBRSR: 2018. Available at: https://www.ebrsr.com.Google Scholar

Canadian Journal of Neurological Sciences | Cambridge Core

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[Abstract] Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial

Abstract

OBJECTIVE:

We investigated the treatment effects of a home-based rehabilitation program compared with clinic-based rehabilitation in patients with stroke.

DESIGN:

A single-blinded, 2-sequence, 2-period, crossover-designed study.

SETTING:

Rehabilitation clinics and participant’s home environment.

PARTICIPANTS:

Individuals with disabilities poststroke.

INTERVENTIONS:

During each intervention period, each participant received 12 training sessions, with a 4-week washout phase between the 2 periods. Participants were randomly allocated to home-based rehabilitation first or clinic-based rehabilitation first. Intervention protocols included mirror therapy and task-specific training.

MAIN OUTCOME MEASURES:

Outcome measures were selected based on the International Classification of Functioning, Disability and Health. Outcomes of impairment level were the Fugl-Meyer Assessment, Box and Block Test, and Revised Nottingham Sensory Assessment. Outcomes of activity and participation levels included the Motor Activity Log, 10-meter walk test, sit-to-stand test, Canadian Occupational Performance Measure, and EuroQoL-5D Questionnaire.

RESULTS:

Pretest analyses showed no significant evidence of carryover effect. Home-based rehabilitation resulted in significantly greater improvements on the Motor Activity Log amount of use subscale (P=.01) and the sit-to-stand test (P=.03) than clinic-based rehabilitation. The clinic-based rehabilitation group had better benefits on the health index measured by the EuroQoL-5D Questionnaire (P=.02) than the home-based rehabilitation group. Differences between the 2 groups on the other outcomes were not statistically significant.

CONCLUSIONS:

The home-based and clinic-based rehabilitation groups had comparable benefits in the outcomes of impairment level but showed differential effects in the outcomes of activity and participation levels.

 

via Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized… – PubMed – NCBI

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[NEWS] Telemedicine-Delivered Arm Rehab Results on Par with In-Person Clinic

Published on 

Rehab muscle training for elbow joint

 

Post-stroke arm motor function recovery progressed just as well, whether the exercises were performed via home-based telemedicine or in an office environment, according to a randomized trial discussed recently at the International Stroke Conference.

Improvement in arm motor function on the Fugl-Meyer scale was 7.86 points with telerehab versus 8.36 points at day 30, which met noninferiority criteria, Steven Cramer, MD, of the University of California Irvine, reports, in a media release from Medpage Today.

Arm recovery exceeded the minimal clinically important difference in both groups and didn’t differ between rehab strategies by aphasia status.

“What we’re trying to do with home-based telehealth does not compete with or replace traditional rehab medicine. It is expanding tools,” Cramer adds.

ISC session moderator Louise McCullough, MD, PhD, of the University of Texas Health Science Center at Houston, agreed but noted some advantages to rehab from home.

“If we can optimize it… there could be huge cost savings,” she comments, “and especially for people in rural areas, like lots of Texas does not have access to rehab. It might be 2 hours away. This gives more options for people.”

The NIH StrokeNet trial included 124 adults who were 4 to 36 weeks post-ischemic or hemorrhagic stroke and had a baseline arm motor Fugl-Meyer score of 22 to 56 on the 66-point scale.

Treatment consisted of 36 sessions (18 supervised) of 70 minutes each, over 6 to 8 weeks. Intensity, duration, and frequency of therapy were matched between groups. Participants were randomized to therapy at home via telemedicine or in a traditional clinic setting with the same Accelerated Skill Acquisition program (impairment focused, task specific, and with intensive engagement), the release explains.

Telerehab patients started their supervised sessions with a video conference where they worked with the therapist.

For the 15 minutes of the session that was functional training, the in-clinic group got functional tasks whereas the home-based group got functional games. “This is not your father’s Wii game,” Cramer notes, in the release.

The games could be set to emphasize targets in specific parts of the visual field and could vary in speed, range of motion, target size, and cognitive demand. Input devices to play the games ranged from a squeezing device to a “whack-a-mole” mallet and a gun.

Patients’ preference to go to clinic appears to be because of that live social interaction. McCullough continues. “We now know social isolation is very common. But if you have low vision or you live alone, it’s really difficult to get to clinic. So now we have to get it so the preference is to do it at home.”

“I think that social interaction is going to be really important to fold into our telemedicine and telehealth platforms for whatever disease,” she adds.

[Source: Medpage Today]

 

via Telemedicine-Delivered Arm Rehab Results on Par with In-Person Clinic – Rehab Managment

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[Poster Abstract] GameBall: the development of a novel platform to provide enjoyable and affordable hand and arm rehabilitation following stroke

Purpose: Poor arm recovery post-stroke can lead to increased dependence, reduced quality of life, and is a strong predictor of lower psychological well being following stroke. Effective treatment interventions are characterised by repetitive practice. This repetitive nature can make doing exercises boring, and coupled with a lack of community resources ongoing rehabilitation of the arm is challenging. Therefore effective home-based stroke rehabilitation devices that are motivating and enjoyable to use, and affordable are needed.

First page of article

via GameBall: the development of a novel platform to provide enjoyable and affordable hand and arm rehabilitation following stroke – Physiotherapy

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[Abstract + References] Monitoring System for Home-Based Hand Rehabilitation – IEEE Conference Publication

Abstract

The paper proposes a solution for monitoring of cardiovascular parameters during home-based hand rehabilitation. The most important cause of long-term disability in Europe is cerebral vascular accident (CVA) or stroke. The effects of stroke can vanish after a short period or can remain for the rest of the life depending on therapeutic program. The system developed for this study is not only therapeutically devices that allow the movement of hand for physical exercises controlled by electromyography (EMG) but also record one or more biomedical parameters such as: electromyogram (EMG), electrocardiogram (ECG), pulse wave, heart rate (HR), temperature, respiration rate, non-invasive blood pressure (NIBP) or oxygen concentration in the blood (SpO2). These physiological parameters are selected according to the physician’s prescription and the patient needs. In this paper it is presented an application that refers to the hand rehabilitation of post-stroke. It was observed the cardiovascular system status, analyzing the heart rate variability. During therapeutic procedure it was recorded ECG (1 lead) and pulse wave (using an ear lobe sensor). After that HRV was calculated for each signal. The results were used to determine the stress level induced by the rehabilitation program.
1. I.I. Costache, E. Miftode, O. Petriş, A.D. Popa, D. Iliescu, E.G. Botnariu, “Associations between Area of residence and Cardiovascular risk”, Revista de cercetare şi intervenţie socială, vol. 49, pp. 68-79, May 2015.

2. V.L. Roger, A.S. Go, D.M. Lloyd-Jones, E.J. Benjamin, J.D. Berry, W.B. Borden, D.M. Bravata, S. Dai, E.S. Ford, C.S. Fox, H.J. Fullerton, C. Gillespie, S.M. Hailpern, J.A. Heit, V.J. Howard, B.M. Kissela, S.J. Kittner, D.T. Lackland, J.H. Lichtman, L.D. Lisabeth, D.M. Makuc, G.M. Marcus, A. Marelli, D.B. Matchar, C.S. Moy, D. Mozaffarian, M.E. Mussolino, G. Nichol, N.P. Paynter, E.Z. Soliman et al., “Heart disease and stroke statistics–2012 update: a report from the American Heart Association”, Circulation, vol. 125, pp. e2-e220, 2012.

3. P.U. Heuschmann, A. Di Carlo, Y. Bejot, D. Rastenyte, D. Ryglewicz, C. Sarti, M. Torrent, C.D. Wolfe, “Incidence of stroke in Europe at the beginning of the 21st century”, Stroke, vol. 40, pp. 1557-1563, May 2009.

4. I.I. Costache, E. Miftode, O. Mitu, V. Aursulesei, “Sex differences in cardiovascular risk factors in a rural community from north Romania region”, Revista de cercetare şi intervenţie socială, vol. 55, pp. 204-214, 2016.

5. E. Stevens, C. McKevitt, E. Emmett, C. Wolfe, Y. Wang, “The Burden of Stroke in Europe”, report for Stroke Alliance for Europe, 2017.

6. J. Chen, D. Nichols, E.B. Brokaw, P.S. Lum, “Home-Based Therapy After Stroke Using the Hand Spring Operated Movement Enhancer (HandSOME)”, IEEE Transactions on Neural Systems and Rehabilitation Engineering, vol. 25, no. 12, pp. 2305-2312, 2017.

7. M. Ciorap, M. Munteanu, D. Andritoi, R. Ciorap, “Low Cost Device for “at Home” Rehabilitation After a Stroke Event”, International conference KNOWLEDGE-BASED ORGANIZATION, vol. 24, pp. 26-31, 2018, [online] Available: http://doi.org/10.1515/kbo-20180132.

8. A. Basteris, S.M. Nijenhuis, A.HA. Stienen, J.H. Buurke, G.B Prange, F. Amirabdollahian, “Training modalities in robot-mediated upper limb rehabilitation in stroke: a framework for classification based on a systematic review”, Journal of NeuroEngineering and Rehabilitation, vol. 11, no. 111, 2014.

9. S.M. Hunter, H. Johansen-Berg, N. Ward, N.C. Kennedy, E. Chandler, C.J. Weir, J. Rothwell, A.M. Wing, M.J. Grey, G. Barton, N.M. Leavey, C. Havis, R.N. Lemon, J. Burridge, A. Dymond, V.M. Pomeroy, “Functional Strength Training and Movement Performance Therapy for Upper Limb Recovery Early Poststroke-Efficacy Neural Correlates Predictive Markers and Cost-Effectiveness: FAST-INdiCATE Trial”, FRONTIERS IN NEUROLOGY, vol. 8, 2018.

10. A. Pollock, B. St George, M. Fenton, L. Firkins, “Top ten research priorities relating to life after stroke”, Lancet Neurology, vol. 11, no. 3, pp. 209, 2012.

11. M.T. Schultheis, A.A. Rizzo, “The application of virtual reality technology in rehabilitation”, Rehabil Psychol, vol. 46, no. 3, pp. 296-311, 2001.

12. H. Sveistrup, “Motor rehabilitation using virtual reality”, Journal of Neuro Engineering and Rehabilitation, vol. 1, no. 10, 2004.

13. R. Ciorap, D. Arotariţei, F. Topoliceanu, R. Lupu, C. Corciovă, M. Ungureanu, “E-health application for home monitoring of neuromuscular rehabilitation”, [Aplicaţie e-Health pentru monitorizarea la domiciliu a recuperării neuro-musculare] Revista Medico-Chirurgicală a Societăţii de Medici şi Naturalişti din Iaşi, vol. 109, no. 2, pp. 440-444, 2005.

14. F. Wittmann, J.P. Held, O. Lambercy, M.L. Starkey, A. Curt, R. Hover, R. Gassert, A.R. Luft, R.R. Gonzenbach, “Self-directed arm therapy at home after stroke with a sensor-based virtual reality training system”, Journal of Neuroengineering and Rehabilitation, vol. 13, 2016.

15. F. Muri, C. Carbajal, A.M. Echenique, H. Fernandez, M. Lopez, “Virtual reality upper limb model controlled by EMG signals”, Journal of Physics Conference Series 477 19th Argentinean Bioengineering Society Congress (SABI 2013).

16. R. Ciorap, C. Hritcu-Luca, C. Corciova, A. Stan, D. Zaharia, “Home Monitoring Device for Cardiovascular Diseases”, International Conference on Advancements of Medicine and Health Care through Technology, pp. 49-52, 23-26 Septembrie, 2009.

17. A.J. Meyer, C. Patten, B.J. Fregly, “Lower extremity EMG-driven modeling of walking with automated adjustment of musculoskeletal geometry”, PLOS ONE, vol. 12, no. 7, 2017.

18. R. Ciorap, D. Andritoi, V. Pomazan, L. Petcu, F. Ungureanu, D. Zaharia, “E-health system for monitoring of chronic diseases”, World Congress on Medical Physics and Biomedical Engineering, vol. 25, no. 5, pp. 259-262, 7 – 12 September 2009.

19. V. David, A. Salceanu, R. Ciorap, “Acquisition and Analysis of Biomedical Signals in Case of Peoples Exposed to Electromagnetic Fields” in Pervasive and Mobile Sensing and Computing for Healthcare Subhas Chandra Mukhopadhyay and O. A. Postolache, Springer, pp. 269-295, 2012.

20. V.M. Pomazan, L.C. Petcu, S.R. Sintea, R. Ciorap, “Active Data Transportation and Processing for Chronic Diseases Remote Monitoring”, International Conference on Signal Processing Systems (ICSPS 2009), pp. 853-857, 15-17 May, 2009.

21. R. Ciorap, C. Corciova, M. Ciorap, D. Zaharia, “Optimization of the Treatment for Chronic Disease Using an e-Health System”, 7th International Symposium on ADVANCED TOPICS IN ELECTRICAL ENGINEERING 2011 Bucureşti, pp. 143-146, 12-14 Mai, 2011.

22. D. Andriţoi, V. David, R. Ciorap, “An Portable Device for ECG and Photoplethysmographic Signal Acquisition”, 2014 International Conference and Exposition on Electrical and Power Engineering (EPE2014), 16-18 October 2014.

23. M. Ciorap, M. Munteanu, D. Andritoi, R. Ciorap, “Low Cost Device for at Home Rehabilitation After a Stroke Event”, International conference KNOWLEDGE-BASED ORGANIZATION, vol. 24, no. 3, pp. 26-31, [online] Available: http://doi.org/10.1515/kbo-2018-0132.

24. I.I. Costache, M.C. Ungureanu, D. Iliescu, A. Petriş, G. Botnariu, “Electrocardiographic changes in the most frequent endocrine disorders associated with cardiovascular diseases. Review of the literature”, Revista Medico-Chirurgicală a Societăţii de Medici şi Naturalişti din Iaşi, vol. 119, no. 1, pp. 9-13, 2015.

25. I.I. Costache, R. Al Namat, F. Mitu, M. Ciocoiu, V. Aursulesei, O. Mitu, A.D. Costache, D. Marcu, A.M. Buburuz, “The Prognostic Value of Left Bundle Branch Block and Biochemical Parameters in Alcoholic Dilated Cardiomyopathy”, REV. CHIM., vol. 68, no. 12, pp. 2967-2969, 2017.

26. D. Andriţoi, C. Corciovă, C. Luca, D. Matei, R. Ciorap, “Heart Rate dynamics study on the impact of “Mirror therapy” in patients with stroke”, International Conference Advancements of Medicine and Health Care Through Technology MEDITECH 2016, 12th – 15th October 2016.

27. D. Andritoi, V. David, R. Ciorap, M. Branzila, “Recording and processing electrocardiography signals during magneto therapy procedures”, Environmental Engineering and Management Journal, vol. 12, no. 6, pp. 1231-1238, 2013.

 

via Monitoring System for Home-Based Hand Rehabilitation – IEEE Conference Publication

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[Abstract] Home-based Technologies for Stroke Rehabilitation: A Systematic Review

Highlights

-The types of technology of reviewed articles include games, telerehabilitation, robotic devices, virtual reality devices, sensors, and tablets.

-Two main human factors in designing home-based technologies for stroke rehabilitation are discussed: designing for engagement (including external and internal motivation) and designing for the home environment (including understanding the social context, practical challenges, and technical proficiency).

Abstract

Background

Many forms of home-based technology targeting stroke rehabilitation have been devised, and a number of human factors are important to their application, suggesting the need to examine this information in a comprehensive review.

Objective

The systematic review aims to synthesize the current knowledge of technologies and human factors in home-based technologies for stroke rehabilitation.

Methods

We conducted a systematic literature search in three electronic databases (IEEE, ACM, PubMed), including secondary citations from the literature search. We included articles that used technological means to help stroke patients conduct rehabilitation at home, reported empirical studies that evaluated the technologies with patients in the home environment, and were published in English. Three authors independently conducted the content analysis of searched articles using a list of interactively defined factors.

Results

The search yielded 832 potentially relevant articles, leading to 31 articles that were included for in-depth analysis. The types of technology of reviewed articles included games, telerehabilitation, robotic devices, virtual reality devices, sensors, and tablets. We present the merits and limitations of each type of technology. We then derive two main human factors in designing home-based technologies for stroke rehabilitation: designing for engagement (including external and internal motivation) and designing for the home environment (including understanding the social context, practical challenges, and technical proficiency).

Conclusion

This systematic review presents an overview of key technologies and human factors for designing home-based technologies for stroke rehabilitation.

 

via Home-based Technologies for Stroke Rehabilitation: A Systematic Review – ScienceDirect

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[Abstract] Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial

Abstract

Objective

We investigated the treatment effects of a home-based rehabilitation program compared with clinic-based rehabilitation in patients with stroke.

Design

A single-blinded, 2-sequence, 2-period, crossover-designed study.

Setting

Rehabilitation clinics and participant’s home environment.

Participants

Individuals with disabilities poststroke.

Interventions

During each intervention period, each participant received 12 training sessions, with a 4-week washout phase between the 2 periods. Participants were randomly allocated to home-based rehabilitation first or clinic-based rehabilitation first. Intervention protocols included mirror therapy and task-specific training.

Main Outcome Measures

Outcome measures were selected based on the International Classification of Functioning, Disability and Health. Outcomes of impairment level were the Fugl-Meyer Assessment, Box and Block Test, and Revised Nottingham Sensory Assessment. Outcomes of activity and participation levels included the Motor Activity Log, 10-meter walk test, sit-to-stand test, Canadian Occupational Performance Measure, and EuroQoL-5D Questionnaire.

Results

Pretest analyses showed no significant evidence of carryover effect. Home-based rehabilitation resulted in significantly greater improvements on the Motor Activity Log amount of use subscale (P=.01) and the sit-to-stand test (P=.03) than clinic-based rehabilitation. The clinic-based rehabilitation group had better benefits on the health index measured by the EuroQoL-5D Questionnaire (P=.02) than the home-based rehabilitation group. Differences between the 2 groups on the other outcomes were not statistically significant.

Conclusions

The home-based and clinic-based rehabilitation groups had comparable benefits in the outcomes of impairment level but showed differential effects in the outcomes of activity and participation levels.

via Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial – Archives of Physical Medicine and Rehabilitation

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