Posts Tagged home rehabilitation

[ARTICLE] Preliminary Analysis of Perception, Knowledge and Attitude of Home Health Patients Using Tele Rehabilitation in Riyadh, Saudi Arabia – Full Text

ABSTRACT

Telerehabilitation is defined as delivery of rehabilitation services over telecommunication networks and the internet, which comprise of clinical assessment (the patient’s functional abilities in his or her environment) and clinical therapy.This new area  of medical advancement, using state of the art technology is developing at a great speed and is  definitely going to be the next milestone in health care revolution.The objective of this study was to explore the awareness, knowledge and perception of the patients for using telerehabilitation as a medium to provide physiotherapy services as a part of home healthcare services.  A pretest-post test design was used where the home healthcare patients (n = 90) aged between 50 -75 years were asked to express views by given a validated modified TUQ questionnaire followed by an indepth interviewing to develop a key understanding regarding the themes. Interviews were transcribed and a qualitative thematic analysis was conducted. The awareness level regarding the  telerehabilitation changed significantly from 57% to 96% post session(p<0.05). Similarly, the knowledge of the participants regarding  online consultation, followup and online therapy  changed significantly from 50%, 47% and 57% to 96%, 76% and 96% respectively post session of rehabilitation(p<0.05). The perception level regarding the key benefits including  its usage in emergency(83%), convenience of no travel(84%), ease of getting treated at home(97%) and  availability of specialist consultation (84%) were the prime ideas for excellent rating among 95% participants (p<0.05) post session. Findings are helpful to health practitioners in designing their intervention programs across the kingdom. However the actual impact could be only derived from future studies which has to conducted based on different clinical conditions.

Introduction

Telerehabilitation is defined as the provision and delivery of rehabilitation health services at a distance using information and communication technologies and tools (Tan 2005; Russell 2007). Throughout the world, the health care practices is going through major transformation as it is driven through sea change because of the increased use of technology. The kingdom of Saudi Arabia too is witnessing a massive change with significant restructuring of healthcare systems with some major high-end technology driven development solutions. The increased demand is created on account of rapidly increasing saudi population including the growing elderly community, changing disease patterns, global climatic changes and financial inequity (Mahmood 2018).  According to a United nations report the elderly population of Saudi Arabia  those aged 60 and above is projected to increase from 3% in 2010 to 9.5% and 18.4% in 2035 and 2050, respectively (UN Report, 2018).

Similarly, comparing this phenomenon to an average life expectancy of the population in Saudi Arabia, the latest WHO data published in 2018, suggests that Saudi male and female have an average of 73.5 and female 76.5 life years with an average life expectancy of 74.8 years as against an average world life expectancy of 84 years.The increased demand in kingdom also raised because of immense economic pressure with steep fall in global oil prices in 2015-16 affecting the GDP significantly thereby been one of the key stimulus for the government to take timely corrective actions and diversify the economy from heavily oil dependent to develop other verticals for revenue generation (MoH Report, 2018).

Brian child of Crown Prince HH Mohammad Bin Salman, Vision 2030 was adopted in April 2016 and has identified its priorities across all economic sectors and serves as a roadmap for the economic development of the KSA with development of health services been one of the most important key themes. Therefore, as a part of realization of this vision the government strongly supports the partnership of private and public sectors and been seen as a strong indication of the Government’s commitment for making healthcare accessible to its citizens irrespective of the disparities available in the Saudi society (Vision 2030 Report, 2016). Access to healthcare generally relates to people’s ability to use health services when and where they are needed. Determinants of healthcare access are the types and quality of services, including the costs, time, distance (ease of travel) as well as regular interface between service users and healthcare providers. Saudi Arabia is the largest and fastest growing health care market in the region and is estimated to reach $40 billion by 2020 (NTP 2020 Report, 2016).

Moreover, the steep increase in the number of hospitals across all major cities of KSA are run by both government and private organizations which use  corporate business strategies and technology driven specializations, which aim to create demand as well as attract high number patients as the facilities in majority of these hospitals are world class.Among the various strategies listed in the NTP Report 2020, one of the key components of making healthcare accessible across the kingdom is the enhanced use of telemedicine (NTP 2020 Report, 2016). In the last one decade the health services across the kingdom have taken gigantic leap jumps with private healthcare taking lead and using innovations in delivering healthcare. One of such innovations is using Home Healthcare for delivering physiotherapy and other rehabilitation based services for the patients at home (Pulse Report 2018).

Rehabilitation is a very important component in medical care and helps in propelling patient to preinjury level. It is a well known fact that in all long term cases which requires follow-ups such as in surgical cases and other debilitating disorders including Stroke, Cancer, Multiple Sclerosios, rehabilitation is time consuming and financially constraining. To add to this, patients travelling long distances for treatment, it is not only physically challenging but emotionally draining too and especially in case of geriatric patients.Therefore home tele rehabilitation programs, are winding up progressively as an elective method of service delivery. In the western countries, quite a number of research studies has been proved that the Telerehabilitation for the delivery of health services is quite effective, however the scope of using such services in the kingdom is still novice and requires a detailed study, (Hailey et al., 2010, Johansson and Wild 2011, Chang et al 2019     ).

There are scant studies to prove its efficacy in the developing countries as its successful will depends on a number of factors (Clemens et al 2018) . However, among all the variables, the two most important are the technological component and second been its implementation in real terms (Jackson and McClean 2012, Clemens et al 2018). Accordingly, these both are of extreme critical importance from the patient satisfaction point of view. The perceptions of the stakeholders, i.e. the patient and the members of the Rehabilitation team are of utmost importance for its use and wide spread application.The home healthcare services in Saudi Arabia is still in infancy stages with few delivery partners across the kingdom. The usage of telerehabilitation is even more nascent, as the perception of patients in using such a technology for delivering healthcare would be quite critical and important to understand the phenomenon which would be quite useful in framing the guidelines for its applications at a mass level, (Alaboudi et al 2016).

Therefore, this study is an attempt to study the awareness, knowledge and perceptions of  the home healthcare patients in using physiotherapy services delivered via cloud based telerehabilitation. This study, to our knowledge is the first of its kind in the kingdom especially from the perspective of home healthcare patients. It aims to explore the key ideas which might work in favour or against the successful implementation of telerehabilitation used for the home healthcare delivery.

Materials and Methods

The pretest-post test study design was conducted on home healthcare patients so as to obtain an in-depth understanding of the patients’ perception about telerehabilitation services which they will receive as a part of home health services. While a few studies  conducted earlier emphasized about telemedicine to be a key part in delivery of health services, however none of the studies emphasized on perception of patients to implement telerehabilitation as part of home healthcare (Clemens et al 2018, Khalil et al 2018).

Due necessary approval were taken from the ethical clearance committee of the respective organization, which is a reputed home healthcare organization based in Riyadh. In order to recruit participants for the study, sample population were selected from a pool of home healthcare patients who were undergoing treatment under one of the most prominent home healthcare organizations in the kingdom, which incidentally was the only first licensed stand-alone home healthcare services company in Riyadh province.

The study was conducted from Jan 15 to May 30, 2019. In this context, non-probability sampling method was used. Out of 113 home healthcare patients who underwent treatment for different ailments, 90 were randomly selected who also gave their consent to participate in the study out of which 57 were males and 33 were females. Those patients who suffered from orthopedic problems such as Knee pain, low back ache, disc prolapse etc. or underwent orthopedic surgeries such as knee replacement or meniscectomy etc. participated in the study. The study mainly included common geriatric patients for the study who were willing to participate but excluded the pediatric and the critical care, neurological and cardiac patients as they underwent major surgeries such as for stroke or CABG and also were unable to respond directly to answer the questions. The patients who were able respond in English or Arabic were recruited for the study.

Based on literature review and discussion with key stakeholders, a questionnaire and an the interview guide was prepared, modified from Telehealth Usability Questionnaire (TUQ) based on key themes of perceived usefulness, ease of use and learnability,  Interaction quality, Reliability and Satisfaction and future use (Langbecker et al 2017) . The questionnaire was converted to Arabic version adapted from the original English version and pilot tested for the home healthcare patients using both forward and backward translation methods and achieved very acceptable score of confirmatory factor analysis of 0.78 using SPSS. It was also pilot tested   for the members of the rehabilitation team. The questionnaires as given in Appendix 1 were responded by the patients and the members of the rehabilitation team followed by a semi structured individual interview from the patient as well as from the team members involved in providing home health services. The interviews were audio recorded and transcribed verbatim using Text Analysis Markup System (TAMS) Analyzer as suggested by Yin (Yin 2013).

The Tele-rehabilitation Technological solutions were a part of home health services which were delivered by the company. As a part of cloud based HIPAA compliant network, the telemedicine unit consists of a portal to track health metrics and rehabilitation treatment plan and progress by the PT specialists as well as the Case Managers. The system included case briefing, consultation by specialists as well as providing physiotherapy sessions both by Home health therapists or via health workers such as PTAs within the vicinity of home environment at patient’s ease as schematically represented in Fig. no.1.

Figure 1: Set-up for in-home telerehabilitation: (A) Framework system; (B) dashboard Screen (C) Integrated loop with benefits

The participants were given a pre and post session modified TUQ and asked to reflect on their entire rehabilitation experience using the Telerehabilitation platform so as to get relevant information about telemedicine services including key events such as finding out they would receive services at home by videoconference, having the internet and videoconferencing equipment installed at home and receiving services by videoconference including dealing with technical issues. Following the same detailed interview was taken using the TAMS so as to identify key ideas which can affect usage of telerehabilitation. . Statistical tests was conducted  using SPSS for Pre-post differences evaluation. using paired  t-tests to assess factors associated with awareness, knowledge and perception. Significance was set a priori at p < 0.05. […]

Continue —> Preliminary Analysis of Perception, Knowledge and Attitude of Home Health Patients Using Tele Rehabilitation in Riyadh, Saudi Arabia

, , ,

Leave a comment

[ARTICLE] Stroke patients’ and non-professional coaches’ experiences with home-based constraint-induced movement therapy: a qualitative study – Full Text

To investigate the experiences of chronic stroke patients and non-professional coaches with home-based constraint-induced movement therapy (homeCIMT).

Qualitative study embedded within a cluster randomized controlled trial investigating the efficacy of homeCIMT to improve the use of the affected arm in daily activities.

Patients’ home environment.

13 stroke patients and 9 non-professional coaches’ alias family members who had completed the four-week homeCIMT programme in the context of the HOMECIMT trial.

Semi-structured interviews; qualitative data were analysed using the methodology of the hermeneutic phenomenological data analysis.

We identified six themes in the qualitative analysis describing the experiences of patients and non-professional coaches with homeCIMT: (1) homeCIMT can be integrated into everyday life with varying degrees of success; (2) training together may produce positive experiences as well as strain; (3) self-perceived improvements during and following homeCIMT; (4) using the affected arm in everyday life is challenging; (5) subjective evaluation of and experiences with homeCIMT-specific exercises; and (6) impact of professional therapists’ guidance and motivation during homeCIMT. Statements regarding theme five and six were only provided by patients, whereas the other themes contain both, the experiences of stroke patients and non-professional coaches.

Patients’ and non-professional coaches’ narratives offer a detailed insight into the manifold experiences with the practical implementation of homeCIMT that may help improve implementing the homeCIMT programme and similar approaches involving increased training duration and intensity and/or involvement of family members.

 

In stroke rehabilitation, repetitive, task-specific training is one of the key principles.1,2 For stroke patients with upper limb dysfunction, constraint-induced movement therapy and its modifications are one of the most promising techniques taking this principle into account.14 To induce the use of the affected arm in everyday life,5 constraint-induced movement therapy comprises an intensive motor training, the use of adherence-enhancing behavioural methods and the immobilization of the non-affected hand.5,6 A four-week home-based training in conjunction with the support of a non-professional coach (e.g. family member) and reduced professional assistance to meet ambulatory care conditions (home-based constraint-induced movement therapy (homeCIMT)) is one way to deliver constraint-induced movement therapy to patients in long-term care.7 The HOMECIMT trial showed homeCIMT to be superior to conventional therapies with regard to the self-perceived use of the stroke-affected arm in daily activities.8

HomeCIMT and other forms of constraint-induced movement therapy have been shown to be particularly effective in improving upper limb function post stroke.1,3 However, these interventions will only work if patients adhere to them. Constraint-induced movement therapy requires numerous hours of repetitive exercises, which are likely to present a challenge for patients.9,10 Regarding homeCIMT, the involvement of a non-professional coach might be an additional challenging aspect for both, patients and non-professional coaches. Thus, it is vital to better understand the users’ experiences with different forms of constraint-induced movement therapies in order to adapt the way how we deliver these interventions and maximize adherence to them. However, there are only few investigations with the users’ perspectives on constraint-induced movement therapies. We are only aware of three minor qualitative studies investigating the experiences of two or three patients with modified constraint-induced movement therapies.1113 A qualitative research approach, in particular, provides information about the users’ experiences with the practical application of a therapy.14,15

In addition to the cluster randomized controlled HOMECIMT trial, we conducted a comprehensive qualitative study to explore the users’ perspectives on homeCIMT following the driving question: What are the experiences of chronic stroke patients and non-professional coaches with homeCIMT?[…]

 

Continue —> Stroke patients’ and non-professional coaches’ experiences with home-based constraint-induced movement therapy: a qualitative study – Anne Stark, Christine Färber, Britta Tetzlaff, Martin Scherer, Anne Barzel, 2019

Figure 1. Themes regarding the experiences of patients and non-professional coaches with homeCIMT.

 

, , , , , , , , ,

Leave a comment

[WEB SITE] HOMEREHAB – Development of Robotic Technology for Post-Stroke Home Tele-Rehabilitation – The European Coordination Hub for Open Robotics Development

homerehab1

Rehabilitation can help hemiparetic patients to learn new ways of using and moving their weak arms and legs. With immediate therapy it is also possible that people who suffer from hemiparesis may eventually regain movement. However, reductions in healthcare reimbursement place constant demands on rehabilitation specialists to reduce the cost of care and improve productivity. Service providers have responded by shortening the length of patient hospitalisation.

The HOMEREHAB project will develop a new tele-rehabilitation robotic system for delivering therapy to stroke patients at home. It will research on the complex trade-off between robotic design requirements for in home systems and the performance required for optimal rehabilitation therapies, which current commercial systems designed for laboratories and hospitals do not take into account. Additionally, the new home scenario also demands for the smart monitoring of the patient’s physiological state, and the adaptation of the rehabilitation therapy for an optimal service.

 

Contact:

Universidad Miguel Hernández de Elche (UMH)
Nicolas M. Garcia-Aracil
Email: Nicolas.garcia@umh.es
Internet: www.umh.es

 

CEIT – Centro de Estudios e Investigaciones Técnicas
Iñaki Díaz
Email: idiaz@ceit.es
Internet: www.ceit.es

 

Instead Technologies
Alejandro García Moll
Email: Alejandro.garciam@gouhm.umh.es
Internet: www.gouhm.uhm.es

umh

 

 

ceit

 

capture

via HOMEREHAB – Development of Robotic Technology for Post-Stroke Home Tele-Rehabilitation – The European Coordination Hub for Open Robotics Development

, , , , , ,

Leave a comment

[ARTICLE] An Upper Extremity Rehabilitation System Using Efficient Vision-Based Action Identification Techniques – Full Text PDF

Abstract

This study proposes an action identification system for home upper extremity rehabilitation.
In the proposed system, we apply an RGB-depth (color-depth) sensor to capture the image sequences of the patient’s upper extremity actions to identify its movements. We apply a skin color detection technique to assist with extremity identification and to build up the upper extremity skeleton points.
We use the dynamic time warping algorithm to determine the rehabilitation actions. The system presented herein builds up upper extremity skeleton points rapidly. Through the upper extremity of the human skeleton and human skin color information, the upper extremity skeleton points are effectively established by the proposed system, and the rehabilitation actions of patients are identified by a dynamic time warping algorithm. Thus, the proposed system can achieve a high recognition rate of 98% for the defined rehabilitation actions for the various muscles.
Moreover, the computational speed of the proposed system can reach 125 frames per second—the processing time per frame is less than 8 ms on a personal computer platform. This computational efficiency allows efficient extensibility for future developments to deal with complex ambient environments and for implementation in embedded and pervasive systems.
The major contributions of the study are:
  1. The proposed system is not only a physical exercise game, but also a movement training program for specific muscle groups;
  2. The hardware of upper extremity rehabilitation system included a personal computer with personal computer and a depth camera. These are economic equipment, so that patients who need this system can set up one set at home;
  3. patients can perform rehabilitation actions in sitting position to prevent him/her from falling down during training;
  4. The accuracy rate of identifying rehabilitation action is as high as 98%, which is sufficient for distinguishing between correct and wrong action when performing specific action trainings;
  5. The proposed upper extremity rehabilitation system is real-time, efficient to vision-based action identification, and low-cost hardware and software, which is affordable for most families.

via “An Upper Extremity Rehabilitation System Using Efficient Vision-Based Action Identification Techniques” by Yen-Lin Chen

, , , , , , , ,

Leave a comment

[Abstract] Home-based hand rehabilitation with a robotic glove in hemiplegic patients after stroke: a pilot feasibility study

Objective: To evaluate the feasibility and safety of home rehabilitation of the hand using a robotic glove, and, in addition, its effectiveness, in hemiplegic patients after stroke.

Methods: In this non-randomized pilot study, 21 hemiplegic stroke patients (Ashworth spasticity index ≤ 3) were prescribed, after in-hospital rehabilitation, a 2-month home-program of intensive hand training using the Gloreha Lite glove that provides computer-controlled passive mobilization of the fingers. Feasibility was measured by: number of patients who completed the home-program, minutes of exercise and number of sessions/patient performed. Safety was assessed by: hand pain with a visual analog scale (VAS), Ashworth spasticity index for finger flexors, opponents of the thumb and wrist flexors, and hand edema (circumference of forearm, wrist and fingers), measured at start (T0) and end (T1) of rehabilitation. Hand motor function (Motricity Index, MI), fine manual dexterity (Nine Hole Peg Test, NHPT) and strength (Grip test) were also measured at T0 and T1.

Results: Patients performed, over a mean period 56 (49–63) days, a total of 1699 (1353–2045) min/patient of exercise with Gloreha Lite, 5.1 (4.3–5.8) days/week. Seventeen patients (81%) completed the full program. The mean VAS score of hand pain, Ashworth spasticity index and hand edema did not change significantly at T1 compared to T0. The MI, NHPT and Grip test improved significantly (p = 0.0020, 0.0156 and 0.0024, respectively) compared to baseline.

Conclusion: Gloreha Lite is feasible and safe for use in home rehabilitation. The efficacy data show a therapeutic effect which need to be confirmed by a randomized controlled study.

 

via Home-based hand rehabilitation with a robotic glove in hemiplegic patients after stroke: a pilot feasibility study: Topics in Stroke Rehabilitation: Vol 0, No 0

, , , , , , , , ,

Leave a comment

[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

, , , , , , , , , , , ,

Leave a comment

[Abstract] Delivering Remote Rehabilitation at Home: An Integrated Physio-Neuro Approach to Effective and User Friendly Wearable Devices – SpringerLink

Abstract

There is a global shortage of manpower and technology in rehabilitation to attend to the five million new patients who are left disabled every year with stroke. Neuroplasticity is increasingly recognized to be a primary mechanism to achieve significant motor recovery. However, most rehabilitation devices either limit themselves to mechanical repetitive movement practice at a limb level or focus only on cognitive tasks. This may result in improvements in impairment but seldom translates into effective limb and hand use in daily activities. This paper presents an easy-to-use, wearable upper limb system, SynPhNe (pronounced like “symphony”), which trains brain and muscle as one system employing neuroplasticity principles. A summary of clinical results with stroke patients is presented. A new, wireless, home-use version of the solution architecture has been proposed, which can make it possible for patients to do guided therapy at home and thus have access to more therapy hours.

Source: Delivering Remote Rehabilitation at Home: An Integrated Physio-Neuro Approach to Effective and User Friendly Wearable Devices | SpringerLink

, , , , ,

Leave a comment

[WEB SITE] RAPAEL Smart Glove Receives CES 2017 Innovation Award – Rehab Managment

The RAPAEL Smart Glove, a wearable device from NEOFECT, Burlingame, Calif, offers at-home game-based hand therapy for stroke patients who cannot visit a clinic due to economic or geographic reasons.

Simply wear the glove, connect to the “RAPAEL” app, and play the rehabilitation games.

The Smart Glove—a CES 2017 Innovation Awards Honoree for the hospital edition—leads the patient through games that stimulate daily activities, in one or two 30-minute sessions per day.

Built-in sensors capture the patient’s movement and positioning data, and transfer it via Bluetooth to a tablet, where it is analyzed. This analysis enables the games’ difficulty levels to be adjusted and the patient’s exercise schedule to be customized.

Training movements include forearm supination/pronation, wrist flexion/extension, wrist radial/ulnar deviation, and finger flexion/extension, per the company’s website.

[Source: NEOFECT]

Source: RAPAEL Smart Glove Receives CES 2017 Innovation Award – Rehab Managment

, , , , , , , , , , ,

Leave a comment

[WEB SITE] “Virtual physiotherapist” helps paralysed patients exercise using computer games – Medical News Today

A simple device can improve the ability of patients with arm disability to play physiotherapy-like computer games, according to new research.

The low-cost invention, called gripAble™, consists of a lightweight electronic handgrip, which interacts wirelessly with a standard PC tablet to enable the user to play arm-training games. To use it, patients squeeze, turn or lift the handgrip, and it vibrates in response to their performance whilst playing. The device uses a novel mechanism, which can detect the tiny flicker movements of severely paralysed patients and channel them into controlling a computer game.

Special-training computer games, controlled by the device, have been designed for people with no previous experience of using computers. For example one computer game requires the user to squeeze repeatedly to slowly reveal a photograph.

In a new study published in PLOS ONE, researchers from Imperial College London have shown that using the device increased the proportion of paralysed stroke patients able to direct movements on a tablet screen by 50 per cent compared to standard methods. In addition, the device enabled more than half of the severely disabled patients in the study to engage with arm-training software, whereas none of the patients were able to use conventional control methods such as swiping and tapping on tablets and smartphones.

Over five million people in the UK live with arm weakness – approximately one million of them following a stroke, plus others who have neurological and musculoskeletal conditions. Arm weakness contributes to physical disability that requires expensive long-term care. For example, treatment for stroke costs the NHS £9 billion a year, which is five per cent of the total NHS budget. The only intervention shown to improve arm function is repetitive, task-specific exercise but this is limited by the cost and availability of physiotherapists.

The gripAble™ device is designed for patients to use unsupervised in hospital and at home. The research tested the gripAble™ device with stroke patients who had suffered successive strokes with arm paralysis at Imperial College Healthcare NHS Trust over six months. The researchers assessed their ability to use gripAble™ to control mobile gaming devices such as tablets that could be used for rehabilitation and compared this to their use of conventional methods such as swiping and tapping.

They found that 93 per cent of patients were able to make meaningful movements to direct the cursor as a result of using gripAble™. In contrast, 67 per cent of patients were able to use mobile gaming devices by swiping on a tablet. For other types of control over the tablet, such as tapping or using joysticks, the number of patients able to make meaningful movements was lower.

The success of the device was most apparent for patients with severe arm weakness: no patients in this group were able to use conventional controls to play training games, whereas 58% could use gripAble™.

In a smaller sub-group the trial also demonstrated that severely disabled patients could play computer games that involve tracking a target with almost as good accuracy as healthy people.

The clinical trial was carried out at Charing Cross Hospital, part of Imperial College Healthcare Trust, between 2014 and 2015. The team is now carrying out a feasibility study in North West London to test the use of the device in patients’ homes.

The potential of gripAble™ as a means of delivering cost-effective physiotherapy was recognised by a NHS England Innovation Challenge Prize in early 2016.

Lead researcher Dr Paul Bentley, who is a Clinical Senior Lecturer at Imperial College London and Honorary Consultant Neurologist at Imperial College Healthcare NHS Trust , said: “In the UK 100,000 new cases of arm weaknesses are diagnosed each year following a stroke. Often this impairs people’s ability to carry out daily activities, requiring long-term care. The use of mobile-gaming could provide a cost-effective and easily available means to improve the arm movements of stroke patients but in order to be effective patients of all levels of disability should be able to access it.

“We have developed the gripAble™ device to improve arm and cognitive function of patients who have mild to severe arm weaknesses. Unlike other therapies currently on the NHS, gripAble™ is a low cost device which can be used in hospitals and independently by patients at home. As such it could potentially help save the health service millions of pounds. We now intend to further develop the device so we can help more patients who are currently suffering from the effects of poor arm and upper body mobility.”

The researchers collaborated with Human Robotics Group at Imperial College London to develop the device. The research is funded by the Imperial Confidence in Concept Award, the NHS England Innovation Challenge Prize, and the EU 7th Framework Programme for Research and Technological Development grants.

The gripAble™ device is an example of the work of the Imperial Academic Health Science Centre (AHSC). This is a partnership between Imperial College London and three NHS Trusts, which aims to improve patient outcomes by harnessing scientific discoveries and translating them as quickly as possible into new diagnostics, devices and therapies, in the NHS and beyond. The researchers are working with Imperial Innovations, the College’s technology transfer partner, to spinout gripAble™ as a digital healthcare start-up to commercialise the device.

Article: Democratizing neurorehabilitation: how accessible are low-cost mobile-gaming technologies for self-rehabilitation of arm disability in stroke? Rinne P, Mace M, Nakornchai T, Zimmerman K, Fayer S, Sharma P, et al., PLoS ONE, doi:10.1371/journal.pone.0163413, published 5 October 2016.

Source: “Virtual physiotherapist” helps paralysed patients exercise using computer games – Medical News Today

, , , , , ,

Leave a comment

[ARTICLE] Use of NeuroEyeCoach™ to Improve Eye Movement Efficacy in Patients with Homonymous Visual Field Loss – Full Text

Abstract

Visual field deficits are common in patients with damaged retinogeniculostriate pathways. The patient’s eye movements are often affected leading to inefficient visual search. Systematic eye movement training also called compensatory therapy is needed to allow patients to develop effective coping strategies. There is a lack of evidence-based, clinical gold-standard registered medical device accessible to patients at home or in clinical settings and NeuroEyeCoach (NEC) is developed to address this need. In three experiments, we report on performance of patients on NEC compared to the data obtained previously on the earlier versions of the search task (); we assessed whether the self-administered computerised tasks can be used to monitor the progress () and compared the findings in a subgroup of patients to a healthy control group. Performance on cancellation tasks, simple visual search, and self-reported responses on activities of daily living was compared, before and after training. Patients performed similarly well on NEC as on previous versions of the therapy; the inbuilt functionality for pre- and postevaluation functions was sensitive to allowing assessment of improvements; and improvements in patients were significantly greater than those in a group of healthy adults. In conclusion, NeuroEyeCoach can be used as an effective rehabilitation tool to develop compensatory strategies in patients with visual field deficits after brain injury.

1. Introduction

We explore our surrounding environment by moving our eyes on average three times per second. The eye movement episodes are punctuated by brief periods (100–300 ms) of fixations. This pattern of activity ensures detailed image processing by the high density cone-receptor region of our central vision [1]. The resultant continuous perception of the stable world relies on amalgamation of lower resolution peripheral vision with high resolution central information in a spatiotopic frame of reference [2]. This dynamic process encompasses the suppression of noise or distractors and selective enhancement of target objects [3]. The selection of candidate targets for subsequent eye movements (saccades) is achieved through a combination of stimulus driven bottom-up and goal driven top-down mechanisms [4].

Visual field deficits often accompany lesions of the visual pathways which in turn disrupt the selection of targets falling within the impaired visual fields [5]. Abnormal patterns of eye movement are reported in approximately 60% of such cases [6]. One method for quantifying disturbances of visual processing is to make use of a visual search paradigm where the patient is required to report the presence or absence of a target amongst distractor items, often but not exclusively, presented on a computer screen [7]. The reaction times are then compared to those for target detection in the sighted field in the same individual or in a group of healthy individuals. The inverse of the slope for a linearly fitted plot of reaction times as a function of the number of distractor items reflects “search efficiency” [8]. In general, for healthy adults when targets and distractors are easily discriminable (pop-out search), the slope is shallow (high efficiency), but steeper slopes are expected when targets and distractors share features (complex or conjunction search).

Eye movement recordings of patients with visual field deficits following brain injury reveal a number of characteristics [9]. These include smaller saccade amplitudes, and, hence, a larger number of fixations; limited exploration of the contralesioned visual field; and more between-hemifield saccades often summarised as disorganised eye movements leading to slower reaction times for targets in contralesioned hemifields. Disturbances of eye movement dynamics are also reported in the sighted (ipsilesioned) hemifield [6, 10].

In clinical practice, the rehabilitation of patients with visual field deficits is often conducted by occupational therapists or low-vision experts. The aim of any intervention is to improve the patient’s interactions with their immediate surrounding and increasing their confidence in tasks such as shopping or commuting. The use of computerised visual search tasks as a rehabilitation tool to improve eye movements after brain injury was first reported in a group of 30 patients [11]. Patients were given systematic practice with large saccadic eye movements to search for targets presented at unpredictable positions in both the affected hemifield and the entire field of gaze. This class of treatment was later extended by use of a visual search paradigm to improve scanning strategy. Simultaneous recording of eye movements in a group of 60 patients provided further evidence for spatially disorganised pattern of eye movements in 60% of cases [6], with improved visual scanning in all 13 cases that underwent visual search training. With better use of the remaining sight as well as efficient search strategy, patients were able to compensate for their partial blindness; hence, the technique has been termed compensatory. This technique with various modifications has been used in 14 studies to date, with a total of 593 patients with homonymous visual field loss and persistent visual disabilities (see Table 1). Indeed a recent systematic review [12] has identified eye movement training as the most promising approach to visual rehabilitation in stroke patients.

Continue —> Use of NeuroEyeCoach™ to Improve Eye Movement Efficacy in Patients with Homonymous Visual Field Loss

, , , , , , ,

Leave a comment

%d bloggers like this: