Posts Tagged Telemedicine

[Abstract] Efficiency in stroke management from acute care to rehabilitation: bedside versus telemedicine consultation

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BACKGROUND: Telemedicine has changed over the last years, becoming an integrated service used in various clinical settings such as stroke units or radiological departments, but also as an important tool for home rehabilitation. Assessment of usefulness and efficiency of performing teleconsultations to manage stroke from acute care hospital to tertiary care rehabilitation hospital has not been referred by scientific literature.
AIM: This article analyzes the process of discharging stroke patients from acute care to intensive rehabilitation, based on the comparison between conventional bedside patient evaluations and teleconsultation patient evaluations, to assess efficiency and efficacy of two different discharging workflows.
DESIGN: Retrospective study.
SETTING: Consultations were carried out between the Acute Care Stroke Unit (ACSU) and the Stroke Rehabilitation Unit (SRU) of Valduce Hospital System.
POPULATION: 257 stroke patients underwent physiatric consultation during 2 years considered in this study and 101 patients were considered eligible for intensive rehabilitation treatment after a physiatric consultation.
METHODS: we compared the efficiency and efficacy of the dismission workflow of bedside medical consultation and teleconsultation over a 12 months period. We considered the following outcome measures: time elapsed between consultation and rehabilitation unit admission, number of re-admissions to acute care hospital, complications occurred during rehabilitation, length of stay in the rehabilitation hospital and clinical outcomes of rehabilitation process.
RESULTS: we observed a significant reduction in waiting time from the acute event to the admission in rehabilitation department, an improvement in efficiency of the admission process itself in the rehabilitation unit and a reduction of clinical complications occurred during rehabilitation period, without changes in rehabilitative outcomes.
CONCLUSIONS: it has been highlighted that the use of telemedicine to perform medical consultation as a tool to evaluate patients eligible for tertiary care rehabilitation hospital admission from stroke care unit is feasible and more efficient when compared with conventional bedside consultations.
CLINICAL REHABILITATION IMPACT: this study reveals teleconsultations as a useful tool to improve efficiency of the stroke management workflow.

 

via Efficiency in stroke management from acute care to rehabilitation: bedside versus telemedicine consultation – European Journal of Physical and Rehabilitation Medicine 2018 Oct 29 – Minerva Medica – Journals

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[Abstract + References] The Transformation of the Rehabilitation Paradigm Across the Continuum of Care – PM&R

Abstract

As healthcare continues to evolve, there are changes in the delivery of care for patients with severe neurologic injuries. Although the acute hospital stay is shortening, physiatrists can play a key role in preparing patients for rehabilitation, minimizing longer-term complications and helping to determine the most appropriate paths for further treatment. Inpatient rehabilitation facilities (IRFs) continue to be an important part of the care continuum for patients with severe injuries, but the role of IRFs has also evolved as patients have been admitted with increasing medical and neurologic complexity and length of stay continues to be reduced. Skilled nursing facilities and subacute facilities continue to evolve, in part to fill the gaps that have developed for patients who are “not yet ready for rehabilitation” and for those whose recovery trajectory has been deemed too slow for IRF. Outpatient care is also changing, in part due to the availability of new rehabilitation interventions as highlighted in other sections of the supplement. Furthermore, telemedicine will provide additional options for expanding specialized care beyond prior geographical limitations. Physiatrists need to be aware of these ongoing changes and the roles that they can play outside of the traditional IRF model of care. This article will focus on the innovations in healthcare delivery and opportunities to maximize outcomes in the current and future models of care.

 

References

  1. Reinstein, L., Foto, M.E., Granger, C.V. et al, Sample Screening Criteria for Review of Admissions to Comprehensive Medical Rehabilitation Hospitals. American Academy of Physical Medicine and RehabilitationChicago, IL1978.
  2. Medical Payment Advisory Commission. MedPAC Report to Congress: Medicare Payment Policy, March 14, 2014, p 65..

  3. Medical Payment Advisory Commission. MedPAC Report to Congress: Medicare Payment Policy. 2003..

  4. CMS adopts inpatient rehabilitation facility coverage requirements (2009, July 31). Available athttps://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2009-Fact-sheets-items/2009-07-314.html..

  5. Medical Payment Advisory Commission. MedPAC Report to Congress: Medicare Payment Policy, 2008..

  6. Medical Payment Advisory Commission. MedPAC Report to Congress: Post-Acute Care Reform, February 17, 2014..

  7. DaVanzo, J.E., El Gamil, A., Li, J.W., Shimer, M., Manolov, N., Dobson, A. Assessment of patient outcomes of rehabilitative care provided in inpatient rehabilitation facilities (IRFs) and after discharge. Final Report 13-127. Dobson, DaVanzo and Associates, LLCVienna, VA2014.
  8. Medicare Payment Advisory Commission (Report to the Congress). Medicare Payment Policy. July 2018..

  9. Medical Payment Advisory Commission. MedPAC Report to Congress: Medicare and the Health Care Delivery System, June 2014, 93-119..

  10. DeJong, G., Tian, W., Hsieh, C.H. et al, Rehospitalization in the first year of traumatic spinal cord injury after discharge from medical rehabilitation. Arch Phys Med Rehabil2013;94:S87–S97.
  11. Hammond, F.M., Horn, S.D., Smout, R.J. et al, Rehospitalization during 9 months after inpatient rehabilitation for traumatic brain injury. Arch Phys Med Rehabil2015;96:S330–S339.
  12. Guo, Y., Persyn, L., Palmer, J.L., Bruera, E. Incidence of and risk factors for transferring cancer patients from rehabilitation to acute care units. Am J Phys Med Rehabil2008;87:647–653.
  13. Truong, A.D., Fan, E., Brower, R.G., Needham, D.M. Bench-to-bedside review: mobilizing patients in the intensive care unit—from pathophysiology to clinical trials. Crit Care2009;13:216.
  14. Lord, R.K., Mayhew, C.R., Korupolu, R. et al, ICU early physical rehabilitation programs: financial modeling of cost savings. Crit Care Med2013;41:717–724.
  15. Giacino, J.T., Whyte, J., Bagiella, E. et al, Placebo-controlled trial of amantadine for severe traumatic brain injury. N Engl J Med2012;366:819–826.
  16. Granger, C.V., Markello, S.J., Graham, J.E., Deutsch, A., Reistetter, T.A., Ottenbacher, K.J. The uniform data system for medical rehabilitation report of patients with traumatic brain injury discharged from rehabilitation programs in 2000–2007. Am J Phys Med Rehabil2010;89:265–278.
  17. National Spinal Cord Injury Statistical Center, Facts and Figures at a GlanceUniversity of Alabama at BirminghamBirmingham, AL2015.
  18. Shoolin, J.S. Clinical decision support and the electronic health record—Applications for physiatry. PM&R2017;9:S34–S40.
  19. Stefanacci, R.G. Admission criteria for facility-based post-acute services. Ann Long-Term Care Clin Care Aging2015;23:18–20.
  20. Alcusky, M., Ulbricht, C.M., Lapane, K.L. Post acute care setting, facility characteristics, and post stroke outcomes: A systematic review. Arch Phys Med Rehabil2018;99:1124–1140.
  21. Werner, R.M., Konetzka, R.T. Trends in post-acute care use among Medicare beneficiaries: 2000-2015. J Am Med Assoc2018;319:1616–1617.
  22. Xian, Y., Thomas, L., Liang, L. et al, Unexplained variation for hospitals’ use of inpatient rehabilitation and skilled nursing facilities after an acute ischemic stroke. Stroke2017;48:2836–2842.
  23. Stein, J., Bettger, J.P., Sicklick, A., Hedeman, R., Magdon-Ismail, Z., Schwamm, L.H. Use of a standardized assessment to predict rehabilitation care after acute stroke. Arch Phys Med Rehabil2015;96:210–217.
  24. Parmanto, B., Saptono, A. Telerehabilitation: State-of-the-art from an informatics perspective. Int J Telerehabil2009;1:73–84.
  25. Dinesen, B., Haesum, L.K.E., Soerensen, N. et al, Using preventive home monitoring to reduce hospital admission rates and reduce costs: A case study of telehealth among chronic obstructive pulmonary disease patients. J Telemed Telecare2012;18:221–225.
  26. Piotrowicz, E., Baranowski, R., Bilinska, M. et al, A new model of home-based telemonitored cardiac rehabilitation in patients with heart failure: Effectiveness, quality of life, and adherence. Eur J Heart Fail2010;12:164–171.
  27. Dobkin, B.H., Dorsch, A.K. The evolution of personalized behavioral intervention technology: Will it change how we measure or deliver rehabilitation?. Stroke2017;48:2329–2334.
  28. Ackerman, M.J., Filart, R., Burgess, L.P., Lee, I., Poropatich, R.K. Developing next-generation telehealth tools and technologies: patients, systems, and data perspectives. Telemed J E Health2010;16:93–95.
  29. Chen, J., Jin, W., Zhang, X.X., Xu, W., Liu, X.N., Ren, C.C. Telerehabilitation approaches for stroke patients: Systematic review and meta-analysis of randomized controlled trials. J Stroke Cerebrovasc Dis2015;24:2660–2668.
  30. Fortune, E., Lugade, V., Morrow, M., Kaufman, K. Validity of using tri-axial accelerometers to measure human movement—Part II: Step counts at a wide range of gait velocities. Med Eng Phys2014;36:659–669.
  31. Peretti, A., Amenta, F., Tayebati, S.K., Nittari, G., Mahdi, S.S. Telerehabilitation: Review of the state-of-the-art and areas of application. JMIR Rehabil Assist Technol2017;4:1–9.
  32. Larson, E.B., Feigon, M., Gagliardo, P., Dvorkin, A.Y. Virtual reality and cognitive rehabilitation: a review of current outcome research. NeuroRehabil2014;34:759–772.
  33. Rose, F.D., Brooks, B.M., Rizzo, A.A. Virtual reality in brain damage rehabilitation: review.Cyberpsychol Behav2005;8:241–262.
  34. Jagos, H., David, V., Haller, M. et al, A framework for (tele-) monitoring of the rehabilitation progress in stroke patients: eHealth 2015 special issue. Appl Clin Inform2015;6:757–768.
  35. Linder, S.M., Rosenfeldt, A.B., Bay, R.C., Sahu, K., Wolf, S.L., Alberts, J.L. Improving quality of life and depression after stroke through telerehabilitation. Am J Occup Ther2015;69:1–10.
  36. Rasmussen, R.S., Ostergaard, A., Kjaer, P. et al, Stroke rehabilitation at home before and after discharge reduced disability and improved quality of life: A randomized controlled trial. Clin Rehabil2016;30:225–236.

via The Transformation of the Rehabilitation Paradigm Across the Continuum of Care – PM&R

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[Poster] A Qualitative Study on a Telehealth System for Home-Based Stroke Rehabilitation

Abstract

Purpose: This abstract reports a qualitative study on a home-based stroke telerehabilitation system. The telerehabilitation system delivers treatment sessions in the form of daily guided rehabilitation games, exercises, and stroke education at the patient’s home. Therapists examine patients then establish regular videoconferences with them via the system to discuss their progress, provide feedback, and adjust treatment. The aims of this study were to investigate patients’ general impressions about the benefits of and barriers to using the telerehabilitation system at home.

Methods: We used a qualitative study design that involved in-depth semi-structured interviews with 10 participants who had completed a 6-week intervention using the telerehabilitation system. Thematic analysis was conducted using the grounded theory approach.

Results: Participants mostly reported positive experiences with the telerehabilitation system. Benefits included observed improvements in limb functions and provision of an outlet for mental tension and anxiety. They mainly valued the following four merits of the system: engaging game experience, flexibility in time and location in using the system, having the therapists accountable, and having less burden on caregivers. In particular, all participants rated highly their experience using the videoconference capability, which provided a channel for therapists to observe, correct, and provide feedback and encouragement to patients. Most patients expressed that they established a personal connection with the therapist through use of the telerehabilitation system. By doing so, they felt less isolated and more positive and connected. Finally, communicating with therapists three times a week also held patients accountable for completing the exercises. Barriers to system use were all logistics-related, such as the lack of physical space at home, which impeded effective use, and poor internet connection at home.

Conclusions: The telerehabilitation system studied provides patients with home-based access to games, exercises, education, and therapists. Based on participants’ qualitative feedback, it is a promising tool to deliver stroke rehabilitation therapies effectively and remotely to patients at home.

 

via Abstract TP154: A Qualitative Study on a Telehealth System for Home-Based Stroke Rehabilitation | Stroke

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[ARTICLE] A Cloud-Based Virtual Reality App for a Novel Telemindfulness Service: Rationale, Design and Feasibility Evaluation – Full Text

ABSTRACT

Background: Worldwide, there has been a marked increase in stress and anxiety, also among patients with traumatic brain injury (TBI). Access to psychology services is limited, with some estimates suggesting that over 50% of sufferers are not accessing the existing services available to them for reasons such as inconvenience, embarrassment, or stigmatization concerns around mental health. Health service providers have increasingly been turning to drug-free therapies, such as mindfulness programs, as complementary treatments.

Objective: Virtual reality (VR) as a new delivery method for meditation-based stress and anxiety reduction therapy offers configurable environments and privacy protection. Our objective was to design a serious learning-meditation environment and to test the feasibility of the developed telemindfulness approach based on cloud technologies.

Methods: We developed a cloud-based system, which consisted of a Web interface for the mindfulness instructor and remote clients, who had 3D VR headsets. The mindfulness instructor could communicate over the Web interface with the participants using the headset. Additionally, the Web app enabled group sessions in virtual rooms, 360-degree videos, and real interactions or standalone meditation. The mindfulness program was designed as an 8-week Mindfulness-Based Stress Reduction course specifically for the developed virtual environments. The program was tested with four employees and four patients with TBI. The effects were measured with psychometric tests, the Mindful Attention Awareness Scale (MAAS) and the Satisfaction With Life Scale (SWLS). Patients also carried out the Mini-Mental State Examination (MMSE). An additional objective evaluation has also been carried out by tracking head motion. Additionally, the power spectrum analyses of similar tasks between sessions were tested.

Results: The patients achieved a higher level of life satisfaction during the study (SWLS: mean 23.0, SD 1.8 vs mean 18.3, SD 3.9) and a slight increase of the MAAS score (mean 3.4, SD 0.6 vs mean 3.3, SD 0.4). Particular insight into the MAAS items revealed that one patient had a lower MAAS score (mean 2.3). Employees showed high MAAS scores (mean 4.3, SD 0.7) and although their SWLS dropped to mean 26, their SWLS was still high (mean 27.3, SD 2.8). The power spectrum showed that the employees had a considerable reduction in high-frequency movements less than 0.34 Hz, particularly with the 360-degree video. As expected, the patients demonstrated a gradual decrease of high-frequency movements while sitting during the mindfulness practices in the virtual environment.

Conclusions: With such a small sample size, it is too early to make any specific conclusions, but the presented results may accelerate the use of innovative technologies and challenge new ideas in research and development in the field of mindfulness/telemindfulness.

Introduction

Attention impairment has often been considered a hallmark of mental illness. Attention training is an important part of meditation, and has proven to augment the ability to sustain attention [1]. Mindfulness as a meditation tool has an important role in psychology, self-awareness, and well-being. The authors Brown and Ryan [2] reported that mindfulness over time was related to a reduction in variable mood and stress in patients with cancer. Mindfulness is an internationally recognized therapy that teaches self-awareness, maintaining own thoughts, sensations, feelings, emotions, and appreciation of your living environment [3]. The mindfulness meditation technique may help patients manage potentially negative outcomes and improve well-being by controlling unselfconsciousness (thoughts on failure). Avoiding problems associated with the future, focusing on the present, being “now,” and controlling the tracking of time may, in addition to well-being, lead to mindfulness. A person who can achieve such an active and open attention state can control thoughts from a distance, free to judge whether they are good or not [4]. In this context, mindfulness can also be considered an important tool for managing anxiety and stress in patients [2]. Kabat-Zinn [3] designed an 8-week meditation course, Mindfulness-Based Stress Reduction, which provides 2 hours of meditation in a group with additional homework. Mindfulness-Based Stress Reduction has demonstrated that awareness of the mind, unconscious thoughts, feelings, and other emotions positively affect major physiological processes and thus decreases the level of stress-related disorders [46].

Anxiety and stress disorders can be related to pressure at work, incurable diseases, or neuromuscular disorders, such as Parkinson disease, light traumatic brain injury (TBI), multiple sclerosis, or other diseases of the muscular or central nervous system. Deficits in executive functions, memory, and learning are often documented after TBI. In addition, at least half of those suffering from TBI experience chronic pain and/or sleep disorders, depression, and substance abuse [7].

A review of the literature shows that neural systems are modifiable networks and changes in the neural structure can occur in adults as a result of training [8]. The study reported on anatomical magnetic resonance imaging (MRI) images from 16 healthy meditation-naïve participants who underwent the 8-week mindfulness program [8]. The results obtained before and after the program suggested that participation in a Mindfulness-Based Stress Reduction course was associated with changes in gray matter concentration in the regions of the brain involved in learning and memory processes, emotion regulation, self-referential processing, and perspective taking.

Early rehabilitation in the acute and subacute phase may be a critical period and a key to effective rehabilitation, especially in TBI [9]. A significant drawback is that patients often stay in hospital for a limited time and are soon discharged for recovery at home. Afterward they can visit an outpatients’ clinic. Patients residing close may find the outpatient service convenient, but it could be very inconvenient for those who are in need of ongoing care, are dependent on public transport, or in the worst case do not have access to transport at all. Consequently, external factors such as travel fatigue may hinder the effectiveness of the therapy and, in some, may even increase anxiety and stress. In addition, modern diseases caused by stress and anxiety in the workplace are on the increase, but access to treatment and therapy is usually not possible during working hours [10].

Innovative technologies can ensure real-time communication and data recording/sharing over long distances, even within larger groups of participants [11]. Nowadays, privacy, data security, shyness, and pride are among the most frequent reasons to avoid therapy if a mental disease or neuromuscular disorder is related to work or social status [12].

Some patients prefer to remain anonymous and do not want to reveal their problems, even to colleagues. The sense of “total immersion” created by virtual reality (VR) is an emerging technology that may entirely replace mainstream videoconferencing techniques [13]. These technologies may fulfill patient expectations [14] regarding anonymity and enhance presence [15]. Patients can hide their identify using an avatar and their voices can be disguised. Psychologists and other experts may observe the kinematic changes in motion patterns, gestures, face mimics, and other measurable features [12]. If there is a group, the VR avatars can be synchronized and controlled in real time, using cloud-based technologies. The operator can form groups, deliver individual or group tasks, or lead a private conversation with selected participants. We have developed a technology that is available for home and workplace use, called Realizing Collaborative Virtual Reality for Well-being and Self-Healing (ReCoVR), for which the VR headset is coupled with a mobile phone. The only requirement is a connection to Wi-Fi/4G Internet, plus communication with the cloud server allows remote interaction with other users residing thousands of miles away.

This cloud-based app is used for interaction and communication between a mindfulness expert and participants. Each participant uses a commercially available mobile phone and a simple head-mounted VR headset to join the mindfulness session in the virtual environment (VE). Our main objectives were to design a suitable mindfulness protocol based on Mindfulness-Based Stress Reduction, with tasks in the VE with 360-degree videos, and to test the feasibility of the developed mindfulness/telemindfulness app in a real environment. Additionally, we analyzed head movements during mindfulness sessions to stimulate further initiatives in this research space. […]

Continue —> JRP-A Cloud-Based Virtual Reality App for a Novel Telemindfulness Service: Rationale, Design and Feasibility Evaluation | Cikajlo | JMIR Research Protocols

Figure 1. The ReCoVR system consists of a cloud server, serving information for the WebGL scenery and synchronization of the data (audio, video, data) between the server and clients. The clients connect to the server as mindfulness experts (using a computer with Web browser) and as mindfulness therapy participants (using Samsung GearVR 3D headset with Wi-Fi/LTE).

Figure 2. The mindfulness instructor uses the Web interface to manage the group therapy in the virtual room. The Web interface enables video-audio communication with the participants (below left), making subgroups, and assigning tasks (right) for mindfulness sessions. Additionally, the therapist can share documents and lead the session, while everybody can send/receive messages and talk to other group members.

 

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[Conference paper] ePHoRt Project: A Web-Based Platform for Home Motor Rehabilitation – Abstract

Abstract

ePHoRt is a project that aims to develop a web-based system for the remote monitoring of rehabilitation exercises in patients after hip replacement surgery. The tool intends to facilitate and enhance the motor recovery, due to the fact that the patients will be able to perform the therapeutic movements at home and at any time. As in any case of rehabilitation program, the time required to recover is significantly diminished when the individual has the opportunity to practice the exercises regularly and frequently. However, the condition of such patients prohibits transportations to and from medical centers and many of them cannot afford a private physiotherapist. Thus, low-cost technologies will be used to develop the platform, with the aim to democratize its access. By taking into account such a limitation, a relevant option to record the patient’s movements is the Kinect motion capture device. The paper describes an experiment that evaluates the validity and accuracy of this visual capture by a comparison to an accelerometer sensor. The results show a significant correlation between both systems and demonstrate that the Kinect is an appropriate tool for the therapeutic purpose of the project.

References

  1. 1.
    Feys, H., De Weerdt, W., Verbeke, G., et al.: Early and repetitive stimulation of the arm can substantially improve the long-term outcome after stroke: a 5-year follow-up study of a randomized trial. Stroke 35(4), 924–929 (2004)CrossRefGoogle Scholar
  2. 2.
    Cramp, M.C., Greenwood, R.J., Gill, M., et al.: Effectiveness of a community-based low intensity exercise programme for ambulatory stroke survivors. Disabil. Rehabil. 32(3), 239–247 (2010)CrossRefGoogle Scholar
  3. 3.
    Mavroidis, C., Nikitczuk, J., Weinberg, B., et al.: Smart portable rehabilitation devices. J. Neuroeng. Rehabil. 2, 18 (2005). doi:10.1186/1743-0003-2-18CrossRefGoogle Scholar
  4. 4.
    Holden, M.K., Dyar, T.A., Dayan-Cimadoro, L.: Telerehabilitation using a virtual environment improves upper extremity function in patients with stroke. IEEE Trans. Neural Syst. Rehabil. Eng. 15(1), 36–42 (2007)CrossRefGoogle Scholar
  5. 5.
    Rand, D., Kizony, R., Weiss, P.T.L.: The Sony PlayStation II EyeToy: low-cost virtual reality for use in rehabilitation. J. Neurol. Phys. Ther. 32(4), 155–163 (2008)CrossRefGoogle Scholar
  6. 6.
    Oikonomidis, I., Kyriazis, N., Argyros, A.A.: Efficient model-based 3D tracking of hand articulations using Kinect. In: Proceedings of the 22nd British Machine Vision Conference. University of Dundee (2011)Google Scholar
  7. 7.
    Rybarczyk, Y., Rybarczyk, P., Oliveira, N., Vernay, D.: e-ESPOIR: a user-friendly web-based tool for disability evaluation. In: Proceedings of the 11th conference of the Association for the Advancement of Assistive Technology in Europe. Maastricht (2011)Google Scholar
  8. 8.
    Mendes, P., Rybarczyk, Y., Rybarczyk, P., Vernay, D.: A web-based platform for the therapeutic education of patients with physical disabilities. In: Proceedings of the 6th International Conference of Education, Research and Innovation, Seville (2013)Google Scholar
  9. 9.
    Rodrigues, F., Rybarczyk, Y., Gonçalves, M.J.: On the use of IT for treating aphasic patients: a 3D web-based solution. In: Proceedings of the 13th International Conference on Applications of Computer Engineering, Lisbon (2014)Google Scholar
  10. 10.
    Rybarczyk, Y., Fonseca, J.: Tangible interface for a rehabilitation of comprehension in aphasic patients. In: Proceedings of the 11th conference of the Association for the Advancement of Assistive Technology in Europe, Maastricht (2011)Google Scholar
  11. 11.
    Birns, J., Bhalla, A., Rudd, A.: Telestroke: a concept in practice. Age Ageing 39(6), 666–667 (2010)CrossRefGoogle Scholar
  12. 12.
    Nguyen, K.D., Chen, I.M., Luo, Z., et al.: A wearable sensing system for tracking and monitoring of functional arm movement. IEEE/ASME Trans. Mechatron. 16(2), 213–220 (2011)CrossRefGoogle Scholar
  13. 13.
    Patel, S., Park, H., Bonato, P., et al.: A review of wearable sensors and systems with application in rehabilitation. J. Neuroeng. Rehabil. 9(1), 21–37 (2012)CrossRefGoogle Scholar
  14. 14.
    Rand, D., Eng, J.J., Tang, P.F., et al.: How active are people with stroke? use of accelerometers to assess physical activity. Stroke 40(1), 163–168 (2009)CrossRefGoogle Scholar
  15. 15.
    Biswas, D., Cranny, A., Maharatna, K.: Body area sensing networks for remote health monitoring. In: Vogiatzaki, E., Krukowski, A. (eds.) Modern Stroke Rehabilitation through e-Health-Based Entertainment, pp. 85–136. Springer, Heidelberg (2016)CrossRefGoogle Scholar
  16. 16.
    Jovanov, E., Milenkovic, A., Otto, C., De Groen, P.C.: A wireless body area network of intelligent motion sensors for computer assisted physical rehabilitation. J. Neuroeng. Rehabil. 2, 6–15 (2005)CrossRefGoogle Scholar
  17. 17.
    Strath, S.J., Kaminsky, L.A., Ainsworth, B.E., et al.: Guide to the assessment of physical activity: clinical and research applications – a scientific statement from the American heart association. Circulation 128(20), 2259–2279 (2013)CrossRefGoogle Scholar
  18. 18.
    Vernay, D., Edan, G., Moreau, T., Visy, J.M., Gury, C.: OSE: a single tool for evaluation and follow-up patients with relapsing-remitting multiple sclerosis. Multiple Sclerosis 12, suppl. 1 (2006)Google Scholar
  19. 19.
    Nilsdotter, A., Bremander, A.: Measures of hip function and symptoms. Arthritis Care Res. 63, 200–207 (2011)CrossRefGoogle Scholar
  20. 20.
    Borg, G.A.: Psychophysical bases of perceived exertion. Med. Sci. Sports Exerc. 14(5), 377–381 (1982)CrossRefGoogle Scholar
  21. 21.
    Gameiro, J., Cardoso, T., Rybarczyk, Y.: Kinect-Sign: teaching sign language to listeners through a game. In: Rybarczyk, Y., et al. (eds.) Innovative and Creative Developments in Multimodal Interaction Systems, pp. 141–159. Springer, Heidelberg (2014)CrossRefGoogle Scholar
  22. 22.
    Rybarczyk, Y., Santos, J.: Motion integration in direction perception of biological motion. In: Proceedings of the 4th Asian Conference on Vision, Matsue (2006)Google Scholar
  23. 23.
    Dutta, T.: Evaluation of the kinect sensor for 3-D kinematic measurement in the workplace. Appl. Ergonomics 43, 645–649 (2012)CrossRefGoogle Scholar
  24. 24.
    Brook, G., Barry, G., Jackson, D., Mhiripiri, D., Olivier, P., Rochester, L.: Accuracy of the microsoft kinect sensor for measuring movement in people with Parkinson’s disease. Gait Posture 39(4), 1062–1068 (2014)CrossRefGoogle Scholar
  25. 25.
    Rybarczyk, Y.: 3D markerless motion capture: a low cost approach. In: Proceedings of the 4th World Conference on Information Systems and Technologies, Recife (2016)Google Scholar
  26. 26.
    Remondino, F., Roditakis, A.: 3D reconstruction of human skeleton from single images or monocular video sequences. In: Proceedings of Joint Pattern Recognition Symposium, Magdeburg (2003)Google Scholar
  27. 27.
    Krukowski, A., Vogiatzaki, E., Rodríguez, J.M.: Patient health record (PHR) system. In: Maharatna, K., et al. (eds.) Next Generation Remote Healthcare: A Practical System Design Perspective. Springer, New York (2013). Chap. 6Google Scholar

via ePHoRt Project: A Web-Based Platform for Home Motor Rehabilitation | SpringerLink

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[Conference paper] Hand Robotic Rehabilitation: From Hospital to Home – Abstract+References

Abstract

Stroke patients are often affected by hemiparesis. In the rehabilitation of these patients the function of the hand is often neglected. Thus in this work we propose a robotic approach to the rehabilitation of the hand of a stroke patient in hospital and also at home. Some experimental results can be presented here especially for inpatients. Further experimental results on home-patients must be acquired through a telemedicine platform, designed for this application. 

References

  1. 1.
    Song D, Lan N, Loeb GE, Gordon J (2008) Model-based sensorimotor integration for multi-joint control: development of a virtual arm model. Ann Biomed Eng 36(6):1033–1048. doi:10.1007/s10439-008-9461-8 CrossRefGoogle Scholar
  2. 2.
    Prange GB, Jannink MJA, Groothuis-Oudshoorn CGM, Hermens HJ, Ijzerman MJ (2006) Systematic review of the effect of robot-aided therapy on recovery of the hemiparetic arm after stroke. J Rehabil Res Dev 43(2):171–183. doi:10.1682/Jrrd.2005.04.0076 CrossRefGoogle Scholar
  3. 3.
    Fulesdi B, Limburg M, Bereczki D, Kaplar M, Molnar C, Kappelmayer J, Neuwirth G, Csiba L (1999) Cerebrovascular reactivity and reserve capacity in type II diabetes mellitus. J Diabetes Complicat 13(4):191–199. doi:10.1016/S1056-8727(99)00044-6 CrossRefGoogle Scholar
  4. 4.
    Mukherjee M, Koutakis P, Siu KC, Fayad PB, Stergiou N (2013) Stroke survivors control the temporal structure of variability during reaching in dynamic environments. Ann Biomed Eng 41(2):366–376. doi:10.1007/s10439-012-0670-9 CrossRefGoogle Scholar
  5. 5.
    Nowak DA (2008) The impact of stroke on the performance of grasping: usefulness of kinetic and kinematic motion analysis. Neurosci Biobehav R 32(8):1439–1450. doi:10.1016/j.neubiorev.2008.05.021 CrossRefGoogle Scholar
  6. 6.
    Salter RB (2004) Continuous passive motion: from origination to research to clinical applications. J Rheumatol 31(11):2104–2105Google Scholar
  7. 7.
    Fu MJ, Knutson JS, Chae J (2015) Stroke rehabilitation using virtual environments. Phys Med Rehabil Clin N Am 26(4):747–757. doi:10.1016/j.pmr.2015.06.001 CrossRefGoogle Scholar
  8. 8.
    Jarrassé N, Proietti T, Crocher V, Robertson O, Sahbani A, Morel G, Roby-Brami A (2014) Robotic exoskeletons: a perspective for the rehabilitation of arm coordination in stroke patients. Front Hum Neurosc 8. doi:10.3389/fnhum.2014.00947
  9. 9.
    Pisotta I, Perruchoud D, Ionta S (2015) Hand-in-hand advances in biomedical engineering and sensorimotor restoration. J Neurosci Methods 246:22–29. doi:10.1016/j.jneumeth.2015.03.003 CrossRefGoogle Scholar
  10. 10.
    Saudabayev A, Varol HA (2015) Sensors for robotic hands: a survey of state of the art. IEEE Access 3:1765–1782. doi:10.1109/ACCESS.2015.2482543 CrossRefGoogle Scholar
  11. 11.
    Schott J, Rossor M (2003) The grasp and other primitive reflexes. J Neurol Neurosurg Psychiatry 74(5):558–560. doi:10.1136/jnnp.74.5.558 CrossRefGoogle Scholar
  12. 12.
    Cruz EG, Kamper DG (2010) Use of a novel robotic interface to study finger motor control. Ann Biomed Eng 38(2):259–268. doi:10.1007/s10439-009-9845-4 CrossRefGoogle Scholar
  13. 13.
    Legnani G, Casolo F, Righettini P, Zappa B (1996) A homogeneous matrix approach to 3D kinematics and dynamics – I. Theory. Mech Mach Theory 31(5):573–587. doi:10.1016/0094-114X(95)00100-D CrossRefGoogle Scholar
  14. 14.
    Borboni A, Mor M, Faglia R (2016) Gloreha-hand robotic rehabilitation: design, mechanical model, and experiments. J Dyn Syst Meas Control Trans ASME 138(11). doi:10.1115/1.4033831
  15. 15.
    Borboni A, Villafañe JH, Mullè C, Valdes K, Faglia R, Taveggia G, Negrini S (2017) Robot-assisted rehabilitation of hand paralysis after stroke reduces wrist edema and pain: a prospective clinical trial. J Manipulative Physiol Ther 40(1):21–30. doi:10.1016/j.jmpt.2016.10.003 CrossRefGoogle Scholar
  16. 16.
    Dobkin BH (2005) Rehabilitation after stroke. N Engl J Med 352(16):1677–1684. doi:10.1056/NEJMcp043511 CrossRefGoogle Scholar
  17. 17.
    Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS (1999) Stroke: neurologic and functional recovery the Copenhagen Stroke Study. Phys Med Rehabil Clin N Am 10(4):887–906Google Scholar
  18. 18.
    Kuptniratsaikul V, Kovindha A, Suethanapornkul S, Massakulpan P, Permsirivanich W, Kuptniratsaikul PSA (2017) Motor recovery of stroke patients after rehabilitation: one-year follow-up study. Int J Neurosci 127(1):37–43. doi:10.3109/00207454.2016.1138474 CrossRefGoogle Scholar
  19. 19.
    Ferrucci L, Bandinelli S, Guralnik JM, Lamponi M, Bertini C, Falchini M, Baroni A (1993) Recovery of functional status after stroke a postrehabilitation follow-up study. Stroke 24(2):200–205CrossRefGoogle Scholar
  20. 20.
    Kelly-Hayes M, Wolf PA, Kase CS, Gresham GE, Kannel WB, D’Agostino RB (1989) Time course of functional recovery after stroke: the Framingham study. Neurorehabilitation Neural Repair 3(2):65–70. doi:10.1177/136140968900300202 CrossRefGoogle Scholar
  21. 21.
    Borghetti M, Sardini E, Serpelloni M (2013) Sensorized glove for measuring hand finger flexion for rehabilitation purposes. IEEE Trans Instrum Meas 62(12):3308–3314. doi:10.1109/TIM.2013.2272848 CrossRefGoogle Scholar

Source: Hand Robotic Rehabilitation: From Hospital to Home | SpringerLink

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[REVIEW] Telerehabilitation: Review of the State-of-the-Art and Areas of Application – Full Text  

ABSTRACT

Background: Telemedicine applications have been increasing due to the development of new computer science technologies and of more advanced telemedical devices. Various types of telerehabilitation treatments and their relative intensities and duration have been reported.

Objective: The objective of this review is to provide a detailed overview of the rehabilitation techniques for remote sites (telerehabilitation) and their fields of application, with analysis of the benefits and the drawbacks related to use. We discuss future applications of telerehabilitation techniques with an emphasis on the development of high-tech devices, and on which new tools and applications can be used in the future.

Methods: We retrieved relevant information and data on telerehabilitation from books, articles and online materials using the Medical Subject Headings (MeSH) “telerehabilitation,” “telemedicine,” and “rehabilitation,” as well as “disabling pathologies.”

Results: Telerehabilitation can be considered as a branch of telemedicine. Although this field is considerably new, its use has rapidly grown in developed countries. In general, telerehabilitation reduces the costs of both health care providers and patients compared with traditional inpatient or person-to-person rehabilitation. Furthermore, patients who live in remote places, where traditional rehabilitation services may not be easily accessible, can benefit from this technology. However, certain disadvantages of telerehabilitation, including skepticism on the part of patients due to remote interaction with their physicians or rehabilitators, should not be underestimated.

Conclusions: This review evaluated different application fields of telerehabilitation, highlighting its benefits and drawbacks. This study may be a starting point for improving approaches and devices for telerehabilitation. In this context, patients’ feedback may be important to adapt rehabilitation techniques and approaches to their needs, which would subsequently help to improve the quality of rehabilitation in the future. The need for proper training and education of people involved in this new and emerging form of intervention for more effective treatment can’t be overstated.

Introduction

In the last few years, telemedicine applications have been increasing due to the development of new computer science technologies and of more advanced telemedical devices. Long-distance communication can be easily achieved by videoconferencing, email, and texting, to name a few. Today there is the possibility of controlling robots, robotic arms, or drones at a distance. Thanks to these advancements, the course of human action has been considerably transformed [1]. During the last 20 years, demographic changes and increased budget allocation in public health have improved new rehabilitative practices [2]. Rehabilitation is an old branch of medicine, but in the last few years, new telecommunication-based practices have been developed all over the world. These particular approaches in the field of rehabilitation are commonly defined as telerehabilitation, which should be considered as a telemedicine subfield consisting of a system to control rehabilitation at a distance [3].

Telerehabilitation has been developed to take care of inpatients, transferring them home after the acute phase of a disease to reduce patient hospitalization times and costs to both patients and health care providers. Telerehabilitation allows for treatment of the acute phase of diseases by substituting the traditional face-to-face approach in the patient-rehabilitator interaction [4]. Finally, it can cover situations in which it is complicated for patients to reach traditional rehabilitation infrastructures located far away from where they live.

Controlled studies on rehabilitation have demonstrated that quick management of an injury or a disease is critical to achieve satisfactory results in terms of increasing a patient’s self-efficacy. Hence, a rehabilitation program should start as soon as possible, be as intensive as possible, be prolonged, and continue during the recovery phase. A major factor is the initiation time, which, in general, should begin as soon as possible. In most cases, the initial stages of rehabilitation, after the occurrence of a disease or injury, could be performed by patients at home even if they need accurate and intensive treatment. For these reasons, telerehabilitation was developed to achieve the same results as would be achieved by the normal rehabilitation process at a hospital or face to face with a physiotherapist. Various types of telerehabilitation treatments and their relative intensities and duration have been reported [5].

The first scientific publication on telerehabilitation is dated 1998 and, in the last few years, the number of articles on the topic has increased, probably because of the emerging needs of people and due to the development of exciting new communication and computer technologies. Figure 1 shows the number of patients treated through telerehabilitation from 1998 to 2008 according to studies published in the international literature [2].

A remarkable increase in the number of patients treated by telerehabilitation is noticeable from 2002 to 2004. After a subsequent decrease, the number of patients assisted by telerehabilitation increased starting from 2007, probably due to the support of new technologies and the overcoming of the initial skepticism to which every new technology is subjected.

Telerehabilitation is primarily applied to physiotherapy [6,7], and neural rehabilitation is used for monitoring the rehabilitative progress of stroke patients [8]. Telerehabilitation techniques mimic virtual reality [912] and rehabilitation for neurological conditions by using robotics and gaming techniques [13]. Quite often, telerehabilitation has been associated with other nonrehabilitative technologies such as remote monitoring of cardiovascular parameters, including electrocardiogram (ECG), blood pressure, and oxygen saturation in patients with chronic diseases [14]. These technologies belong to another telemedicine branch called telemonitoring, which has been widely developed and used in recent years. A few studies were also centered on the economic aspects of the use of telerehabilitation to reduce the costs of hospitalization [15]. We reviewed the status and future perspectives of telerehabilitation by analyzing their impact on patients’ everyday life. The main topics taken into account were (1) the status of telerehabilitation and analysis of the main medical specialties where it is being applied, (2) quality-of-life improvement due to telerehabilitation, and (3) the future of telerehabilitation.

Figure 1. Number of patients treated from 1998 to 2008 through telerehabilitation techniques.

 

Continue —> JRAT-Telerehabilitation: Review of the State-of-the-Art and Areas of Application | Peretti | JMIR Rehabilitation and Assistive Technologies

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[WEB SITE] Undergoing physiotherapy exercises from home now a reality for patients

SINGAPORE: Patients from two healthcare institutions across Singapore will be able to carry out physiotherapy exercises in the comfort of their own homes, after a national tele-rehabilitation pilot was launched on Friday (May 5) by Integrated Health Information Systems (IHiS).

IHiS, Singapore’s healthcare technology agency, developed the system together with T-Rehab, a start-up founded by researchers from the National University of Singapore (NUS). 

To use the service, patients open an app on an iPad – called Smart Health TeleRehab – and put on neck and limb sensors, depending on which part of the body they are exercising. The instructions are available in five languages: English, Mandarin, Bahasa Melayu, Tamil and Tagalog. 

Video demonstrations of the exercises prescribed by the therapists will then be played via the app. The therapist is able to customise the level of difficulty of each exercise, from the number of repetitions to the angle of each limb movement.

The patient’s movements are also recorded for the therapist to review, and to motivate the patient to complete his or her exercises, the system designed to have gaming elements. For instance, there are coloured bars to indicate if the patient has achieved the desired exercise angle, and a counter for the number of repetitions completed. 

After the patient completes the exercises, a record of the patient’s performance is sent to the therapist.

The service is available to those deemed suitable to perform physiotherapy exercises without the physical supervision of a physiotherapist. This includes those recovering from strokes, lower limb joint replacements and amputations, falls and fractures. 

It is currently offered by NTUC Health and TOUCH Home Care. Twelve other institutions including Ang Mo Kio-Thye Hua Kwan Hospital, Khoo Teck Puat Hospital, and the National University Hospital will provide the service by end-2017.

There are 200 sets of tele-rehabilitation equipment available, which is rented out to the healthcare institutions for a fee. IHiS hopes to get 1,000 patients on the programme by the end of the two-year pilot and currently has around 11 patients on the service since February this year, said Mr Chua Chee Yong, director of IHiS’ planning group.

OVERCOMING INCONVENIENCE, HIGH COSTS

This service comes two-and-a-half years after clinical trials were conducted by the researchers from T-Rehab. 

A total of 100 stroke patients were recruited from Ang Mo Kio-Thye Hua Kwan Hospital and the Singapore General Hospital since January 2014, said Dr Gerald Koh, an associate professor and the director of medical undergraduate education at Saw Swee Hock School of Public Health at NUS. He is one of the founders of T-Rehab. 

They chose to develop a tele-rehab system after an earlier study he conducted found that only two out of five patients wanted to continue with rehabilitation after discharge, he said. This is despite close to four out of five of them stating that rehabilitation was useful.

According to Dr Koh, many of them cited inconvenience, high costs and difficulty getting to the rehab centre without a caregiver as the main reasons why they stopped going for rehabilitation.

“The very reason why I need rehabilitation is the very reason why I can’t get to the day rehab centre three times a week,” Dr Koh said of the issue of immobility faced by patients. 

His study found that those who got therapy through tele-rehabilitation recovered as well as those who did their exercises with a therapist present. 

This new service, Dr Koh added, will help to boost rehabilitation participation rate and remove the barriers to carrying out physiotherapy and this will prevent their conditions from deteriorating further.

One of the early adopters of the system, TOUCH Home Care, found that the service benefits both patients and its healthcare workers since it implemented the system in March 2017.

For TOUCH Home Care, the price per session is still the same as a home visit at S$18. However, as the patient is able to carry out the exercises more frequently and at their own time, the hope is that he or she will recover faster and overall, fewer therapy sessions are required, said a physiotherapist at TOUCH Home Care Vivian Lim.

The operator’s therapists have also been more productive.

So far, they spend about 50 minutes on each tele-rehabilitation session, which include prescribing the exercise via the system, reviewing the elderly client’s exercise records and conducting video consultations or calling the patients to provide feedback. A home visit will typically take about 100 minutes, including time to travel from one home to another.

The sessions are not meant to substitute home visits entirely, said Ms Lim, but can replace some of the weekly sessions.

However, not all clients are able to benefit from the new service, as those with conditions such as chronic giddiness and seizures will not be able to perform their exercises without direct supervision, said Ms Rachel Lim, a senior occupational therapist from TOUCH Home Care. 

Some of the seniors also “lack confidence” in using technology, while others may not have the right caregivers at home. “There are some caregivers are also elderly who are frail (themselves), with sensory deficits…they can’t help put on the sensors,” said the occupational therapist.

TOUCH Home Care hopes to get 90 of its 300 clients using the remote rehabilitation tool by the end of this year. It now has seven on board.

MEETING SINGAPORE’S HEALTHCARE NEEDS

The tele-rehabilitation service was developed in light of Singapore’s healthcare landscape, said IHiS’ Mr Chua.

“Our growing ageing population (means) we have more aged elderly in the community… more healthcare workers, including our therapists, are also getting older,” he said. This means that there will be greater demand for rehabilitation services, while there will be a growing need to “stretch our manpower resources”.

The service is one of three telemedicine initiatives that will begin this year. A remote vital signs monitoring system will launch later this year, while a national videoconferencing platform for healthcare services was launched in April.

Source: Undergoing physiotherapy exercises from home now a reality for patients

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[Abstract] A Telehealth Approach to Caregiver Self-Management Following Traumatic Brain Injury: A Randomized Controlled Trial

Abstract

Objective: To determine whether a telephone-based, individualized education and mentored problem-solving intervention would improve outcomes for caregivers of persons with traumatic brain injury (TBI).

Design: Parallel group, randomized controlled trial with blinded outcome assessment.

Setting: General community.

Participants: A total of 153 caregivers (mean age = 49.7 years; 82% female; 54% spouses/partners, 35% parents) of persons with moderate to severe TBI who received acute and/or rehabilitation care at a level I trauma center. Eighty-two percent of participants were evaluated at 6-month follow-up.

Intervention: Individualized education and mentored problem-solving intervention focused on caregivers’ primary concerns delivered via up to 10 telephone calls at 2-week intervals.

Main Outcome Measures: Composite of Bakas Caregiving Outcomes Scale (BCOS) and Brief Symptom Inventory (BSI-18) at 6 months post-TBI survivor discharge. Secondary measures included the Brief COPE.

Results: Caregivers in the treatment arm scored higher on the BCOS-BSI composite (P = .032), with more active coping (P = .020) and less emotional venting (P = .028) as measured by the Brief COPE.

Conclusions: An individualized education and mentored problem-solving approach delivered via telephone in the first few months following community discharge of the TBI survivor resulted in better caregiver outcomes than usual care. Consideration should be given to using this approach to augment the limited support typically offered to caregivers.

Source: A Telehealth Approach to Caregiver Self-Management Following… : The Journal of Head Trauma Rehabilitation

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[Abstract] H-GRASP: the feasibility of an upper limb home exercise program monitored by phone for individuals post stroke

Abstract

Purpose: To investigate the feasibility of a phone-monitored home exercise program for the upper limb following stroke.
Methods: A pre-post double baseline repeated measures design was used. Participants completed an 8-week home exercise program that included behavioural strategies to promote greater use of the affected upper limb. Participants were monitored weekly by therapists over the phone. The following feasibility outcomes were collected: Process (e.g. recruitment rate); Resources (e.g. exercise adherence rate); Management (e.g. therapist monitoring) and Scientific (e.g. safety, effect sizes). Clinical outcomes included: The Chedoke Arm and Hand Inventory, Motor Activity Log, grip strength and the Canadian Occupational Performance Measure.
Results: Eight individuals with stroke were recruited and six participants completed the exercise program. All but one of the six participants met the exercise target of 60 minutes/day, 6 days/week. Participants were stable across the baseline period. The following post-treatment effect sizes were observed: CAHAI (0.944, p = 0.046); MALQ (0.789, p = 0.03) grip strength (0.947, p = 0.046); COPM (0.789, p = 0.03). Improvements were maintained at three and six month follow ups.
Conclusions: Community dwelling individuals with stroke may benefit from a phone-monitored upper limb home exercise program that includes behavioural strategies that promote transfer of exercise gains into daily upper limb use.

  • Implications for Rehabilitation

  • A repetitive, task-oriented home exercise program that utilizes telephone supervision may be an effective method for the treatment of the upper limb following stroke

  • This program is best suited for individuals with mild to moderate level impairment and experience a sufficient level of challenge from the exercises

  • An exercise program that includes behavioural strategies may promote transfer of exercise gains into greater use of the affected upper limb during daily activities

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