The progressive aging of the population and the consequent growth of individuals with neurological diseases and related chronic disabilities, will lead to a general increase in the costs and resources needed to ensure treatment and care services. In this scenario, telemedicine and e-health solutions, including remote monitoring and rehabilitation, are attracting increasing interest as tools to ensure the sustainability of the healthcare system or, at least, to support the burden for health care facilities. Technological advances in recent decades have fostered the development of dedicated and innovative Information and Communication Technology (ICT) based solutions, with the aim of complementing traditional care and treatment services through telemedicine applications that support new patient and disease management strategies. This is the background for the REHOME project, whose technological solution, presented in this paper, integrates innovative methodologies and devices for remote monitoring and rehabilitation of cognitive, motor, and sleep disorders associated with neurological diseases. One of the primary goals of the project is to meet the needs of patients and clinicians, by ensuring continuity of treatment from healthcare facilities to the patient’s home. To this end, it is important to ensure the usability of the solution by elderly and pathological individuals. Preliminary results of usability and user experience questionnaires on 70 subjects recruited in three experimental trials are presented here.
1. Introduction
In recent years we have been witnessing a gradual increase in life expectancy, due to the general improvement in lifestyles and advances in medicine. This phenomenon has led to the progressive aging of the population, with significant consequences for future economic and social policies [1]. Reports on aging by the World Health Organization (WHO) confirm this trend, further indicating that the population over 65 will double and the population over 80 will triple by 2050 [2]. In addition, several studies and reports on global health have highlighted that aging is inherently accompanied by an increase in the number of people with age-related diseases and disabilities [3,4] that need specific health care treatments for prolonged periods. The same reports also show that neurological diseases and acute events such as stroke, which have a prevalence in the older population, are already very common in industrialized countries characterized by greater well-being. Neurological and neurodegenerative diseases, such as dementia and Parkinson’s disease, have a dramatic impact on quality of life since they progressively induce severe and chronic disabilities in the cognitive and motor domains. Stroke is a major cause of comorbidity and disability [5], in which hemiplegia (or hemiparesis) and impaired gait are common consequences of the loss of brain function in cortical motor areas. Parkinson’s disease is recognized as the second most common neurodegenerative disorder after Alzheimer’s disease, and it causes a progressive impairment in motor functions (bradykinesia). In addition, sleep disorders are common comorbidities in the neurological and post-stroke clinical picture that require complex instrumental investigations and specific treatment to avoid consequences in daily activities [6].
This scenario thus imposes significant efforts and challenges for prolonged patient care, and in particular, rehabilitation programs that aim to mitigate the adverse effects and still ensure the best quality of life [7,8,9]. Several studies have also shown that rehabilitation outcomes are better when patients can continue rehabilitation treatment at home [10]. Moreover, it is clear that the health sector will be one of the most affected by the demographic change in the coming years, in terms of the sustainability of health services [11].
To address future challenges in healthcare, solutions based on Information and Communication Technology (ICT) [12] are attracting increasing interest in finding a trade-off between patient needs (quality of life), effectiveness of healthcare services (monitoring and rehabilitation protocols), and sustainability of the healthcare system (cost and resources). For example, ICT solutions could support new patient and disease management strategies based on telemedicine and related applications, thereby moving monitoring and rehabilitation services from health care facilities to home settings [13,14], thus favoring continuous and remote follow-up of patients. However, there are still several barriers that limit its deployment in the home environment, including aspects of usability, acceptability, lack of motivation and skepticism in using digital tools, especially in the elderly and individuals with severe chronic disabilities [10,15,16].
This is the background for the REHOME project [17], whose technological solution is presented in this paper. The project involved twelve partners (including seven small and medium-sized enterprises, three research institutions, and two hospitals) and was developed in a multidisciplinary context of technological and clinical expertise to achieve a helpful, comprehensive, and integrated home solution. The project focuses on the remote monitoring and rehabilitation of cognitive, motor, and sleep disorders originating from neurological diseases and injuries, in particular stroke, mild cognitive impairment, and Parkinson’s disease. To this end, the proposed solution integrates innovative technologies and methodologies able to ensure patient engagement and continuity of care, monitoring, and rehabilitation in supervised and minimally supervised scenarios. The REHOME solution exploits different types of sensors and devices (such as optical sensors, electromyography, commercial and prototypal sensors for physiological signals); innovative methods for rehabilitation (such as virtual reality, exergaming, gamification techniques); traditional and gamified motor tasks, derived from standardized clinical scales, to evaluate patients’ current condition; estimation of objective features to quantify the patients’ performance and progression over time. At the same time, it facilitates communication and interaction between doctor, patient, and caregiver through the infrastructure of the healthcare platform and its web-based facilities.
In recent years, home-based rehabilitation has been widely considered and many solutions have been developed for this purpose, as evidenced by some recent literature reviews. The study by Hosseiniravandi et al. [18] compared twenty-two solutions for remote rehabilitation focused primarily on five categories of diseases and disorders, including musculoskeletal, neurological, respiratory, cardiovascular, and other general health-related problems. The analysis revealed that these solutions shared three common functionalities, namely exercise plan management, outcome reporting, and patient education. There were also many similarities in terms of methods to collect data: automatic data collection (85%), recording of patient treatment progress (90%), and providing periodic (75%) and real-time (85%) feedback to therapists and patients. In contrast, the study did not focus on the hardware components and devices used in the solutions analyzed, nor on the real-world implemented systems, infrastructure, and the effects of these systems in real world settings. The study by de Souza et al. [19] examined fourteen home-based rehabilitation frameworks based on gaming or exergaming approaches. The findings of the study showed that most of the solutions (79%) focused on stroke, motor, and cognitive rehabilitation. In addition, only 22% of them were cloud-based applications. In [20], a detailed overview of telerehabilitation and its fields of application was provided, with an analysis of the benefits and drawbacks associated with its use. The study highlighted the main disadvantages of telerehabilitation, including patient skepticism due to remote interaction with therapists. The study also suggested that further research is needed to improve electronic equipment and devices, and to make applications as flexible as possible to increase the reliability and effectiveness of telerehabilitation equipment for treating patients with specific problems. The effectiveness of telerehabilitation was investigated in post-stroke subjects and individuals with mild cognitive impairment in [21,22], respectively. Both studies concluded that telerehabilitation can be an appropriate alternative to the usual rehabilitation care.
However, as also pointed out by the previously mentioned state-of-the-art studies, several challenges remain [15,23]. For example, patient satisfaction, patient involvement, and acceptability of the proposed remote rehabilitation approach are generally given little consideration. The same occurs for physical discomfort caused by sensors and devices, which are often invasive or complex to use. In most cases, a single methodological approach is provided that is not suitable for different therapeutic areas, pathological conditions, usage scenario, and current patient status. In addition, a proper user interface design, which is critical especially in the case of people with disabilities, is often neglected. Finally, the lack of adequate training on the use of technological devices and solutions is another common weakness that often prevents patients from using them effectively and continuing the planned therapeutic treatment.
The REHOME project, and the implemented solution, addressed some of the weaknesses highlighted, such as increasing patient involvement; understanding and addressing the specific and necessary functions for the different target pathologies (each with its own peculiarities); managing the personalized treatment plan and evaluating the effectiveness of remote treatment; addressing aspects related to usability, taking care of the user interface, interaction methods, and the simplicity of the devices involved; integrating multiple sensors and methodological approaches to evaluate different domains (motor, cognitive, and sleep) but common to the target pathologies. All these features represent the innovative and peculiar aspect of the proposed solution with respect to the state-of-the-art.
Currently, the project is in its final experimental phase at hospitals. However, some pilot trials were previously organized with the aim of obtaining feedback on the usability of some tools included in the implemented solution. The main objective of the paper is to present the preliminary results related to usability, one of the key elements is to propose a suitable and helpful solution for remote monitoring and rehabilitation. Specifically, the contributions of this work concern the following points:
Introducing the technological solution developed in the REHOME project, highlighting its main components, innovative features, and methodological approaches to meet the needs of patients and healthcare professionals and overcome the main weaknesses of telemedicine and eHealth services that emerge in the literature;
Presenting three experimental protocols concerning the motor and cognitive platforms that involved groups of elderly patients affected by Parkinson’s disease (and forms of atypical parkinsonism) and mild cognitive impairment, target pathologies of the REHOME project;
Presenting the preliminary results on the usability and user experience evaluation using questionnaires administered to the participants to get feedback on the strengths and weaknesses of the developed platforms.
Indeed, it should be noted that this paper is an extended and more detailed version of the one recently presented at the second IEEE Conference on ICT solutions for eHealth (ICTS4eHealth 2022) [24].
The next sections are organized as follows: Section 2 presents the implemented solution, describing the overall architecture and its main components, with a focus on those considered for usability evaluation; Section 3 presents the main results on the usability questionnaires according to the organized pilot trials; Section 4 contains discussion and future developments; Section 5 contains some concluding remarks.
2. Materials and Methods
2.1. The Architecture of the Solution
REHOME is a tele-rehabilitation system for personalized and gamified patient training and monitoring by Healthcare Professionals (HCPs). Patients at home can carry out exercises according to their own rehabilitation plan by using the enabling device kit provided by the doctor. Rehabilitation and health evaluation session data are then collected to allow remote and timely analysis and, if deemed necessary, improvements to the plan.
As depicted in Figure 1, the REHOME system, developed with cloud technologies and based on a distributed microservices architecture, is composed of several subsystems:
HCP Platform (HCPP): to monitor patients remotely and to assess their progress;
Cognitive Rehabilitation and Gaming Platform (CRGP): based on gaming to train five different cognitive domains and to improve memory and orientation skills;
Motor Rehabilitation and Exergames Platform (MREP): for automatic assessment and rehabilitation of motor disabilities concerning limbs, posture, balance, and coordination;
Sleep Evaluation Platform (SEP): to detect and evaluate sleep disorders.
With the development of the social economy, the demand for rehabilitation medical devices is also increasing. However, most rehabilitation devices on the market currently have problems such as bulky equipment, inconvenient operation, and high cost. Taking hand grasp force as the main monitoring parameter, this paper designs a low-cost hand rehabilitation system that is convenient to use, can remotely monitor the progress of hand rehabilitation. The system can well solve the large volume of equipment caused by the complex structure of the existing hand rehabilitation equipment. It can also solve the problems that the device cannot obtain the data of the patient’s recovery in real-time and the use cost is too high. The system includes five modules: flexible pressure sensor module, voltage conversion module, microcomputer module, LCD module and NB-IoT communication module. The flexible pressure sensor module can be attached to the patient’s hand to monitor the recovery data in real-time and see the recovery progress visually on the LCD screen. In addition, rehabilitation data can be uploaded remotely through the NB-IoT communication module for remote guidance by professional doctors to speed up the process of hand rehabilitation.
Tele-rehabilitation has flourished in recent years. The aim of this study was to develop a remote rehabilitation program adapted to regional needs. Due to the high density of medical resources, people in Taiwan can easily and frequently enter has medical institutions. However, this has caused crowds in medical institutions and has affected the quality of rehabilitation for stroke survivors. Upper extremity impairments after a stroke result in functional limitations that impinge on the daily lives of stroke survivors. Task-oriented training (TOT) has been shown to improve recovery after a stroke. In this study, a tele-rehabilitation system, called TOT@home, was designed to enhance the quality of rehabilitation in clinics and facilitate home-based TOT training with remote monitoring.
Remote rehabilitation systems allow the supervision and monitoring of physical exercises by therapists without the need to move, temporally and spatially, the patients who perform them. The main advantage of this approach is the patient’s increased autonomy and flexibility to carry out rehabilitation from home, especially in situations of lock-down and movement restrictions. In order to make the execution of repetitive exercises more dynamic and to motivate patients to perform them from home, in recent years gamification techniques, exergames, and serious games have been extensively used. In this context, and to increase the remote monitoring capabilities of therapists, this paper proposes the use of a language for the specification of exergames oriented to the definition, by therapists, of key performance indicators and mobility constraints adapted to the rehabilitation process of each patient. The sentences of this language can be processed by software, allowing the automatic generation of personalised games for rehabilitation. A case study describing an exergame for the upper limb rehabilitation of stroke patients is also presented.
nEureka® for Epilepsy: a multi-modal, lifestyle-changing epilepsy remote care solution
nEureka® is a patient-first, data-centric remote monitoring platform, enabling personalized, efficient and accessible care for chronic neurological disorders.
With nEureka®, we would like to add more cheer, hope, and create a reduced-stress lifestyle—what we call the ‘nEureka® Lifestyle’—for people with epilepsy and their loved ones”— Ray Iskander, CEO
ALAMEDA, CALIFORNIA, USA, October 30, 2020 /EINPresswire.com/ — Novela Neurotech, a NeuroData company enabling personalized remote care for chronic neurological conditions, will showcase its nEureka® for Epilepsy smartwatch-based platform at the virtual Epilepsy Awareness Day at Disneyland (EADDL), November 2 at 9:30 AM PT.
EADDL is the world’s largest epilepsy awareness and education expo, each year attracting thousands of attendees to Disneyland Resorts. This year, the expo will feature over 100 presentations by the nation’s leading epilepsy experts, neurosurgeons and advocates in a virtual format. Novela will be joining the list of presenters to introduce nEureka®, a multi-modal, lifestyle-changing solution for epilepsy management to the epilepsy community.
Epilepsy is one of the most common chronic neurological disorders. Over 3 million people in the U.S. are diagnosed with epilepsy, which is characterized by unpredictable seizures. The current status quo for epilepsy healthcare relies on punctuated clinical visits—often three months apart—which delays critical healthcare decisions for epilepsy management. Roughly 70% of epilepsy cases can be controlled with medication, and medication adherence is a key factor for keeping seizures at bay.
However, current options for tracking seizures and medication, such as paper or digital notes, are antiquated, inaccurate, and often lack critical health information needed for better care. Existing options are also tedious and time-consuming, and their intrusive nature require patients and caregivers to change their daily routines to accommodate seizure and medication tracking. This creates a friction-full lifestyle for people with epilepsy and their loved ones .
nEureka® for Epilepsy: a lifestyle-changing solution
nEureka® for Epilepsy combines everyday smartwatch devices, a cloud data platform and real-time alerts into a powerful all-in-one, multi-modal Epilepsy Remote Care Solution that resolves current pain points.
nEureka® was created under the scientific and clinical guidance of premier epileptologists, and fine-tuned with feedback from people with epilepsy and caregivers. By involving both critical user groups during development, nEureka® is uniquely positioned in meeting the needs of multiple stakeholders. For patients, it’s designed to be comfortable, fashionable and effortlessly functional while providing patients access to unprecedented health data and control over their own health—seamlessly creating the independent lifestyle they seek. For physicians, nEureka® allows anytime access to continuous patient data to improve care. Currently, 90 days or longer can lapse between visits. nEureka® transforms episodic epilepsy care into continuous care, allowing patients and physicians to launch remote visits —anytime, anywhere.
“Disneyland is a magical destination full of cheer and hope. With nEureka®, we would like to add more cheer, hope, and create a reduced-stress lifestyle—what we call the ‘nEureka® Lifestyle’—for people with epilepsy and their loved ones,” says Ray Iskander, CEO of Novela Neurotech.
About nEureka® nEureka® by Novela Neurotech is a patient-first data-centric remote monitoring platform, enabling personalized, efficient and accessible care for epilepsy & other chronic neurological conditions. nEureka® leverages everyday consumer technology and wearables to connect patients with their clinicians and caregivers resulting in continuous care and significantly reducing disease risks and care costs. For more information, contact shelly.fan@novelaneuro.com.
About EADDL EADDL is organized by Sofie’s Journey, a nonprofit organization dedicated to epilepsy awareness and education. More here.
The statistics highlights that physical rehabilitation are required nowadays by increased number of people that are affected by motor impairments caused by accidents or aging. Among the most common causes of disability in adults are strokes or cerebral palsy. To reduce the costs preserving the quality of services new solutions based on current technologies in the area of physiotherapy are emerging. The remote monitoring of physical training sessions could facilitate for physicians and physical therapists’ information about training outcome that may be useful to personalize the exercises helping the patients to achieve better rehabilitation results in short period of time process. This research work aims to apply physical rehabilitation monitoring combining Virtual Reality serious games and Wearable Sensor Network to improve the patient engagement during physical rehabilitation and evaluate their evolution. Serious games based on different scenarios of Virtual Reality, allows a patient with motor difficulties to perform exercises in a highly interactive and non-intrusive way, using a set of wearable devices, contributing to their motivational process of rehabilitation. The system implementation, system validation and experimental results are included in the paper.
To compare agreement and reliability between clinician-measured and patient self-measured clinical and functional assessments for use in remote monitoring, in a home-based setting, using telehealth.
Trained clinicians measured standard clinical and functional parameters at a face-to-face clinic appointment. Participants were instructed on how to perform the measures at home and to repeat self-assessments within 1-week.
Participants
Eighteen liver transplant recipients [(LTRs), 52 (14)yrs, 56% male, 5.4 (4.3)yrs post-transplant] completed the home self-assessments.
Interventions
Not Applicable
Main Outcome Measures
The outcomes assessed were: body weight, systolic (SBP) and diastolic (DBP) blood pressure, waist circumference, repeated chair sit-to-stand (STST), maximal push-ups and the 6-minute walk test (6MWT). Inter-tester reliability and agreement between face-to-face clinician and self-reported home-based participant measures were determined by intraclass-correlation coefficients (ICCs) and Bland-Altman plots, which were compared with minimal clinically important differences (MCID, determined a priori).
Results
The mean difference (95%CI) and [limits of agreement] for measures (where positive values indicate lower participant value) were: weight, 0.7 (0.01,1.4)kg [-2.2 to 3.6kg]; waist 0.4 (-1.2,2.0)cm [-5.9 to 6.8cm]; SBP, 7.7 (0.6,14.7)mmHg [-19.4 to 34.9mmHg]; DBP, 2.4 (-1.4,6.2)mmHg [-12.2 to 17.0mmHg]; 6MWT, 7.5 (-29.1,44.1)m [-127.3 to 142.4m]; STST, 0.5 (-0.8, 1.7)s [-4.3 to 5.3s]; maximal push-ups, -2.2 (-4.4, -0.1) [-10.5 to 6.0]. ICCs were all >0.75 except for STST (ICC=0.73). Mean differences indicated good agreement compared with MCIDs; however wide limits of agreement indicated large individual variability in agreement.
Conclusions
Overall, LTRs can reliably self-assess clinical and functional measures at home. However, there was wide individual variability in accuracy and agreement, with no functional assessment being performed within acceptable limits relative to MCIDs >80% of the time.
Nowadays, recent advancements in ICT have sped up the development of new services for smart cities in different application domains. One of these is definitely healthcare. In this context, remote patient monitoring and rehabilitation activities can take place either in satellite hospital centres or directly in citizens’ homes. Specifically, using a combination of Cloud computing, Internet of Things (IoT) and big data analytics technologies, patients with motor disabilities can be remotely assisted avoiding stressful waiting times and overcoming geographical barriers. This paper focuses on the Tele-Rehabilitation as a Service (TRaaS) concept. Such a service generates healthcare big data coming from remote rehabilitation devices used by patients that need to be processed in the hospital Cloud. Specifically, after a feasibility analysis, by using a Lokomat dataset as sample, we measured and compared the performances of four of the major NoSQL DBMS(s) demonstrating that the document approach well suits our case study.
Transcranial electrical stimulation is a promising technique to facilitate behavioural improvements in neurological and psychiatric populations. Recently there has been interest in remote delivery of stimulation within a participant’s home.
Objective
The purpose of this review is to identify strategies employed to implement and monitor in-home stimulation and identify whether these approaches are associated with protocol adherence, adverse events and patient perspectives.
Methods
MEDLINE, Embase Classic + Embase, Emcare and PsycINFO databases and clinical trial registries were searched to identify studies which reported primary data for any type of transcranial electrical stimulation applied as a home-based treatment.
Results
Nineteen published studies from unique trials and ten on-going trials were included. For published data, internal validity was assessed with the Cochrane risk of bias assessment tool with most studies exhibiting a high level of bias possibly reflecting the preliminary nature of current work. Several different strategies were employed to prepare the participant, deliver and monitor the in-home transcranial electrical stimulation. The use of real time videoconferencing to monitor in-home transcranial electrical stimulation appeared to be associated with higher levels of compliance with the stimulation protocol and greater participant satisfaction. There were no severe adverse events associated with in-home stimulation.
Conclusions
Delivery of transcranial electrical stimulation within a person’s home offers many potential benefits and appears acceptable and safe provided appropriate preparation and monitoring is provided. Future in-home transcranial electrical stimulation studies should use real-time videoconferencing as one of the approaches to facilitate delivery of this potentially beneficial treatment.
Transcranial electrical stimulation (tES) is a technique used to modulate cortical function and human behaviour. It involves weak current passing through the scalp via surface electrodes to stimulate the underlying brain. A common type of tES is transcranial direct current stimulation (tDCS). Several studies have demonstrated tDCS is capable of modulating cortical function, depending on the direction of current flow [1, 2, 3]. When the anode is positioned over a cortical region, the current causes depolarisation of the neuronal cells, increasing spontaneous firing rates [4]. Conversely, positioning the cathode over the target cortical region causes hyperpolarisation and a decrease in spontaneous firing rates [4]. This modulation of cortical activity can be observed beyond the period of stimulation and is thought to be mediated by mechanisms which resemble long term potentiation and depression [5]. Along similar lines, transcranial alternating current stimulation (tACS) and transcranial random noise stimulation (tRNS) are also forms of tES. Both tACS and tRNS are thought to interact with ongoing oscillatory cortical rhythms in a frequency dependent manner to influence human behaviour [6, 7, 8].
The ability of tES to selectively modulate cortical activity offers a promising tool to induce behavioural change. Indeed, several studies have demonstrated that tES may be a favourable approach to reduce impairment following stroke [9], improve symptoms of neglect [10], or reduce symptoms of depression [11]. While these results appear promising, there remains debate around technical aspects of stimulation along with individual participant characteristics that may influence the reliability of a stimulation response [12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22]. However, current evidence does suggest that effects of stimulation may be cumulative, with greater behavioural improvements observed following repeated stimulation sessions [20]. Furthermore, tES has shown potential as a tool for maintenance stimulation, with potential relapses of depression managed by stimulation which continued over several months [23, 24]. Therefore, it may be that repeated stimulation sessions will become a hallmark of future clinical and research trials aiming to improve behavioural outcomes. This would require participants to attend frequent treatment sessions applied over a number of days, months or years. Given that many participants who are likely to benefit from stimulation are those with higher levels of motor or cognitive impairment, the requirement to travel regularly for treatment may present a barrier, limiting potential clinical utility or ability to recruit suitable research participants [25]. In addition, regular daily treatments would also hinder those who travel from remote destinations to receive this potentially beneficial neuromodulation. Therefore, there is a requirement to consider approaches to safely and effectively deliver stimulation away from the traditional locations of research departments or clinical facilities.
One benefit of tES over other forms of non-invasive brain stimulation, such as repetitive transcranial magnetic stimulation, is the ability to easily transport the required equipment. This opportunity may allow for stimulation to be delivered in a participant’s home, which could represent the mode of delivery for future clinical applications. However, it may be unreasonable to expect that a participant would be capable of managing delivery of tES alone and would likely require some form of training and/or monitoring [25]. Although tES is considered relatively safe [26], stimulation should be delivered within established guidelines to avoid adverse events [27]. Inappropriate delivery of stimulation could result in neural damage, detrimental behavioural effects, irritation, burns or lesions of the skin [28, 29, 30, 31, 32, 33]. Therefore, in order to deliver stimulation safely to the appropriate cortical region, it is likely that in-home stimulation may require some form of monitoring [25].
It is currently unclear what the best approach is to implement and monitor in-home tES. An early paper proposed several guidelines to perform in home tES [34]. However, these guidelines were not based on evidence from published clinical trials as there were none available at the time of publication. One recent systematic review sought to discuss current work in this area and highlighted the need for further research to investigate safety, technical monitoring and assessment of efficacy [35]. Given the recent, and growing, interest in home-based brain stimulation, we felt it was now pertinent to conduct a review to specifically identify strategies employed to implement and monitor the use of in-home tES in neurological and psychiatric populations. The secondary questions were to report protocol adherence, adverse events and patient perspectives of in-home tES. Understanding optimal treatment fidelity for in-home brain stimulation will be instrumental to achieving higher levels of tES useability and acceptance within a participant’s home.[…]
Recent technologic advancements have enabled the creation of portable, low-cost, and unobtrusive sensors with tremendous potential to alter the clinical practice of rehabilitation. The application of wearable sensors to track movement has emerged as a promising paradigm to enhance the care provided to patients with neurologic or musculoskeletal conditions. These sensors enable quantification of motor behavior across disparate patient populations and emerging research shows their potential for identifying motor biomarkers, differentiating between restitution and compensation motor recovery mechanisms, remote monitoring, telerehabilitation, and robotics. Moreover, the big data recorded across these applications serve as a pathway to personalized and precision medicine. This article presents state-of-the-art and next-generation wearable movement sensors, ranging from inertial measurement units to soft sensors. An overview of clinical applications is presented across a wide spectrum of conditions that have potential to benefit from wearable sensors, including stroke, movement disorders, knee osteoarthritis, and running injuries. Complementary applications enabled by next-generation sensors that will enable point-of-care monitoring of neural activity and muscle dynamics during movement also are discussed.
TBI Rehabilitation 