Posts Tagged Tele-rehabilitation
[Abstract] Trial operation of a cloud service-based three-dimensional virtual reality tele-rehabilitation system for stroke patients
[ARTICLE] Preparing a neuropediatric upper limb exergame rehabilitation system for home-use: a feasibility study | Journal of NeuroEngineering and Rehabilitation | Full Text
Home-based, computer-enhanced therapy of hand and arm function can complement conventional interventions and increase the amount and intensity of training, without interfering too much with family routines. The objective of the present study was to investigate the feasibility and usability of the new portable version of the YouGrabber® system (YouRehab AG, Zurich, Switzerland) in the home setting.
Fifteen families of children (7 girls, mean age: 11.3y) with neuromotor disorders and affected upper limbs participated. They received instructions and took the system home to train for 2 weeks. After returning it, they answered questions about usability, motivation, and their general opinion of the system (Visual Analogue Scale; 0 indicating worst score, 100 indicating best score; ≤30 not satisfied, 31–69 average, ≥70 satisfied). Furthermore, total pure playtime and number of training sessions were quantified. To prove the usability of the system, number and sort of support requests were logged.
The usability of the system was considered average to satisfying (mean 60.1–93.1). The lowest score was given for the occurrence of technical errors. Parents had to motivate their children to start (mean 66.5) and continue (mean 68.5) with the training. But in general, parents estimated the therapeutic benefit as high (mean 73.1) and the whole system as very good (mean 87.4). Children played on average 7 times during the 2 weeks; total pure playtime was 185 ± 45 min. Especially at the beginning of the trial, systems were very error-prone. Fortunately, we, or the company, solved most problems before the patients took the systems home. Nevertheless, 10 of 15 families contacted us at least once because of technical problems.
Despite that the YouGrabber® is a promising and highly accepted training tool for home-use, currently, it is still error-prone, and the requested support exceeds the support that can be provided by clinical therapists. A technically more robust system, combined with additional attractive games, likely results in higher patient motivation and better compliance. This would reduce the need for parents to motivate their children extrinsically and allow for clinical trials to investigate the effectiveness of the system.
Data glove, Pediatrics ,Neurorehabilitation, Upper extremities ,YouGrabber, Tele-rehabilitation, Game-based, Cerebral palsy, Children and adolescents, Clinical utility, User satisfaction
[Conference Paper] Monitoring Game-Based Motor Rehabilitation of Patients at Home for Better Plans of Care and Quality of Life – Full Text PDF
This paper describes the biomedical, remote monitoring infrastructure developed and currently tested in the EU REHAB@HOME project to support home rehabilitation of the upper extremity of persons post-stroke and in persons with other neurological disorders, such as Multiple Sclerosis patients, in order to track their progress over therapy and improve their Quality of Life. The paper will specifically focus on describing the initial testing of the tele-rehabilitation system’s components for patients’ biomedical monitoring over therapy, which support the delivery and monitoring of more personalized, engaging plans of care by rehabilitation centers and services.
[ARTICLE] Singapore Tele-technology Aided Rehabilitation in Stroke (STARS) trial: protocol of a randomized clinical trial on tele-rehabilitation for stroke patients – Full Text HTML
Background: Most acute stroke patients with disabilities do not receive recommended rehabilitation following discharge to the community. Functional and social barriers are common reasons for non-adherence to post-discharge rehabilitation. Home rehabilitation is an alternative to centre-based rehabilitation but is costlier. Tele-rehabilitation is a possible solution, allowing for remote supervision of rehabilitation and eliminating access barriers. The objective of the Singapore Tele-technology Aided Rehabilitation in Stroke (STARS) trial is to determine if a novel tele-rehabilitation intervention for the first three months after stroke admission improves functional recovery compared to usual care.
Methods/design: This is a single blind (evaluator blinded), parallel, two-arm randomised controlled trial study design involving 100 recent stroke patients. The inclusion criteria are age ≥40 years, having caregiver support and recent stroke defined as stroke diagnosis within 4 weeks. Consenting participants will be randomized with varying block size of 4 or 6 assuming a 1:1 treatment allocation with the participating centre as the stratification factor. The baseline assessment will be done within 4 weeks of stroke onset, followed by follow-up assessments at 3 and 6 months. The tele-rehabilitation intervention lasts for 3 months and includes exercise 5-days-a-week using an iPad-based system that allows recording of daily exercise with video and sensor data and weekly video-conferencing with tele-therapists after data review. Those allocated to the control group will receive usual care. The primary outcome measure is improvement in life task’s social activity participation at three months as measured by the disability component of the Jette Late Life Functional and Disability Instrument (LLFDI). Secondary outcome variables consist of gait speed (Timed 5-Meter Walk Test) and endurance (Two-Minute Walk test), performance of basic activities of daily living (Shah-modified Barthel Index), balance confidence (Activities-Specific Balance Confidence Scale), patient self-reported health-related quality-of-life [Euro-QOL (EQ-5D)], health service utilization (Singapore Stroke Study Health Service Utilization Form) and caregiver reported stress (Zarit Caregiver Burden Inventory).
Discussion: The goal of this trial is to provide evidence on the potential benefit and cost-effectiveness of this novel tele-rehabilitation programme which will guide health care decision-making and potentially improve performance of post-stroke community-based rehabilitation.
Trial Registration: This trial protocol was registered under ClinicalTrials.gov on 18 July 2013 as study title “The Singapore Tele-technology Aided Rehabilitation in Stroke (STARS) Study” (ID: The STARS Study, ClinicalTrials.gov Identifier: NCT01905917).
Patients with the frozen shoulder condition that limits their arm movement should seek rehabilitation assistance from a medical facility. The normal process is for the patients to travel from their home to a hospital or a medical center to see a physiotherapist. Such potentially cumbersome effort may reduce their motivation and determination to seek proper treatment. Our approach is to use a single smartphone with accelerometer, magnetic field, and gyroscope sensors to provide the necessary monitoring measurements to enable effective tele-rehabilitation. This work proposes a framework for such a system and has successful developed prototype based on the Android platform. Also, there are many different smartphones in the market. Therefore, we evaluated performance of three different smartphones, which are Samsung Google Nexus S, Samsung Galaxy Note 1, and Sony Xperia Z Ultra. According to the experimentation, we have shown that smartphones with the appropriate sensors are suitable for tele-rehabilitation. Also, a newer generation model would provide more precise measurements, as expected.
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Rehabilitation is an important branch of health care that aims to restore some or all of the patient’s physical, sensory, and/or mental capabilities that were lost due to injury, illness, or disease.
With the increasing number of people with disabilities, more specialized rehabilitation staff and facilities are needed. However, evidence suggests that people with disabilities face barriers in accessing the health and rehabilitation services they need in many settings.
Therefore, Telerehabilitation has emerged as an evolutionary field of tele-medicine to overcome this availability problem by providing a wide range of consultative, preventative, diagnostic, and therapeutic services via the internet. Pairing these practices with game-based therapy has proved to increase their potential impact specially with pediatric populations. This paper gives a survey on some existing studies and suggests moving these telerehabilitation games into the cloud for the sake of convenience and flexibility.
[Systematic Review] Integration of emerging motion capture technologies and videogames for human upper-limb telerehabilitation – Full Text PDF
Integrating emerging technologies has shown to have the potential to improve access to rehabilitation services and the adherence for physical therapy when they are applied into telemedicine environments.
This systematic review aims to explore telerehabilitation systems that use motion capture and video games for upper-limb rehabilitation purposes. Motion capture was focused on the information fusion from inertial sensors and other technologies. The search was limited to 2010-2013, from which 667 papers were obtained; afterwards,
duplicate papers were removed, thus, reducing the sample to 57 papers with full text availability. Finally, only 3 of them were selected by approaching the subject of this study.
We conclude that the fusion information from inertial sensors and other motion capture technologies appears to be a new tendency in remote monitoring of motor rehabilitation process. However, the combination of them with active video games in physiotherapy programs is only an emerging research area with promising results.
[ARTICLE] Home-based Computer Assisted Arm Rehabilitation (hCAAR) robotic device for upper limb exercises after stroke: results of a feasibility study in home setting – Full Text PDF
Home-based robotic technologies may offer the possibility of self-directed upper limb exercise after stroke as a means of increasing the intensity of rehabilitation treatment. The current literature has a paucity of robotic devices that have been tested in a home environment. The aim of this research project was to evaluate a robotic device Home-based Computer Assisted Arm Rehabilitation (hCAAR) that can be used independently at home by stroke survivors with upper limb weakness.
hCAAR device comprises of a joystick handle moved by the weak upper limb to perform tasks on the computer screen. The device provides assistance to the movements depending on users ability. Nineteen participants (stroke survivors with upper limb weakness) were recruited. Outcome measures performed at baseline (A0), at end of 8-weeks of hCAAR use (A1) and 1 month after end of hCAAR use (A2) were: Optotrak kinematic variables, Fugl Meyer Upper Extremity motor subscale (FM-UE), Action Research Arm Test (ARAT), Medical Research Council (MRC) and Modified Ashworth Scale (MAS), Chedoke Arm and Hand Activity Inventory (CAHAI) and ABILHAND.
Two participants were unable to use hCAAR: one due to severe paresis and the other due to personal problems. The remaining 17 participants were able to use the device independently in their home setting. No serious adverse events were reported. The median usage time was 433 minutes (IQR 250 – 791 min). A statistically significant improvement was observed in the kinematic and clinical outcomes at A1. The median gain in the scores at A1 were by: movement time 19%, path length 15% and jerk 19%, FM-UE 1 point, total MAS 1.5 point, total MRC 2 points, ARAT 3 points, CAHAI 5.5 points and ABILHAND 3 points. Three participants showed clinically significant improvement in all the clinical outcomes.
The hCAAR feasibility study is the first clinical study of its kind reported in the current literature; in this study, 17 participants used the robotic device independently for eight weeks in their own homes with minimal supervision from healthcare professionals. Statistically significant improvements were observed in the kinematic and clinical outcomes in the study.
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.