Posts Tagged telerehabilitation

[ARTICLE] User-centered design of a patient’s work station for haptic robot-based telerehabilitation after stroke – Full Text

Abstract:

Robotic therapy devices have been an important part of clinical neurological rehabilitation for several years. Until now such devices are only available for patients receiving therapy inside rehabilitation hospitals. Since patients should continue rehabilitation training after hospital discharge at home, intelligent robotic rehab devices could help to achieve this goal. This paper presents therapeutic requirements and early phases of the user-centered design process of the patient’s work station as part of a novel robot-based system for motor telerehabilitation.

1 Introduction

Stroke is one of the dominant causes of acquired disability [1] and it is the second leading cause of death worldwide [2]. The high incidence of the disease and the current demographic developments are likely to increase the number of stroke patients in the future. Most of the survivors have physical, cognitive and functional limitations and require intensive rehabilitation in order to resume independent everyday life [3]. Therefore, the main goal of motor rehabilitation is relearning of voluntary movement capability, a process which takes at least several months, some improvement can occur even after years. In the rehabilitation clinic, patients usually receive a daily intensive therapy program. However, for further improvement of motor abilities, severely affected patients are required to continue their rehabilitation training outside the rehabilitation settings, after being discharged from the rehabilitation clinic. Langhammer and Stanghelle [4] found that a lack of follow-up rehabilitation treatment at home leads to deterioration of activities of daily living (ADL) and to motor functions in general. A possible solution is an individualized and motivating telerehabilitation system in the patient’s domestic environment. Some studies [5], [6] have confirmed the advantage of home rehabilitation after stroke and showed that telerehabilitation received high acceptance and satisfaction, both from patients, as well as from health professionals [7]. Most of the existing telesystems [7], [8] are based on audio-visual conferencing or on virtual environments and contain rather simple software for monitoring patients’ condition. However, in neurological rehabilitation the sensorimotor loop needs to be activated by provision of physiological haptic feedback (touch and proprioception) [3].

Robot-based rehabilitation is currently one of the most prevalent therapeutic approaches. It is often applied in hospitals alongside conventional therapy and is beneficial for motor recovery [9]. Rehabilitation training including a haptic-therapy device may therefore be even more promising for home environments than non-haptic telerehabilitation. Several telerehabilitation systems, which include not only audio and visual, but also haptic modality, already exist [10], [11] . Most of these solutions use low-cost commercial haptic devices (e.g. joysticks) for therapy training, with the goal of cost minimization and providing procurable technology. Nonetheless, devices specifically developed for stroke rehabilitation, which are already established in clinical settings, may have greater impact on motor relearning and could therefore also be more effective at home, compared with existing home rehabilitation devices.

In a previous paper [12], we presented a concept and design overview of a haptic robot-based telerehabilitation system for upper extremities which is currently under development. In the present work, we describe therapeutic requirements, user-centred development [13] and implementation of the patient’s station of the telesystem.

Continue —> User-centered design of a patient’s work station for haptic robot-based telerehabilitation after stroke : Current Directions in Biomedical Engineering

Figure 3 Implementation of the patient’s work station based on Reha-Slide (left) and Bi-Manu-Track (right).

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[Abstract] GEAR: A Mobile Game-Assisted Rehabilitation System

Abstract:

Rehabilitation exercises are an important means for gaining mobility and strength after injuries or surgery. Self-exercising in between physio-therapy sessions is vital for effective rehabilitation. Yet, many people do not follow exercise regimes, which can hamper their recovery. This study proposes GEAR – a mobile GamE Assisted Rehabilitation system – to engage users in self-exercising and to improve adherence to their exercise regime. The system consists of a wearable wristband to monitor users’ movements, a mobile game that incorporates the exercises, and a dashboard to monitor and visualize users’ exercise performance. GEAR has advantages of portability and lower cost as compared to PC or Kinect-based rehabilitation systems. This study describes GEAR and reports on a pilot assessment of its interface and system. The pilot test demonstrates the feasibility of GEAR and provides feedback that is being used to enhance the system prior to full-scale evaluation.

Source: GEAR: A Mobile Game-Assisted Rehabilitation System – IEEE Xplore Document

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[VIDEO] HandTutor Introduction: 2017 Rehabilitation – YouTube

HandTutor Introduction: 2017 Rehabilitation – YouTube

Published on Dec 11, 2016

#1 Technology for Physical and Occupational therapists.

Enjoy the convenience and flexibility of treating your patients remotely with the state of the art MediTouch systems through TeleRehabilitation. TeleRehabilitation sessions enable the therapist to grade the intensity of treatment activities through remote access to their patient’s computer.

Patients are highly motivated by the visual biofeedback they receive. The challenging yet fun customized rehabilitation activities encourage full participation yielding noticeable improvements in range of motion, motor control and functional movements.
Want to know more?
Visit http://meditouch.co.il/products/handt…

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[Abstract] An interactive distance solution for stroke rehabilitation in the home setting – A feasibility study

Background: In this study an interactive distance solution (called the DISKO tool) was developed to enable home-based motor training after stroke. Objectives: The overall aim was to explore the feasibility and safety of using the DISKO-tool, customized for interactive stroke rehabilitation in the home setting, in different rehabilitation phases after stroke. Methods: Fifteen patients in three different stages in the continuum of rehabilitation after stroke participated in a home-based training program using the DISKO-tool. The program included 15 training sessions with recurrent follow-ups by the integrated application for video communication with a physiotherapist. Safety and feasibility were assessed from patients, physiotherapists, and a technician using logbooks, interviews, and a questionnaire. Qualitative content analysis and descriptive statistics were used in the analysis. Results: Fourteen out of 15 patients finalized the training period with a mean of 19.5 minutes spent on training at each session. The DISKO-tool was found to be useful and safe by patients and physiotherapists. Conclusions: This study demonstrates the feasibility and safety of the DISKO-tool and provides guidance in further development and testing of interactive distance technology for home rehabilitation, to be used by health care professionals and patients in different phases of rehabilitation after stroke.

Source: An interactive distance solution for stroke rehabilitation in the home setting – A feasibility study: Informatics for Health and Social Care: Vol 0, No 0

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[Poster] Feasibility of Telerehabilitation in Stroke Recovery: A Survey on Access and Willingness to Use Low-Cost Consumer Technologies

To investigate the access to consumer technologies and willingness to use them to receive rehabilitation services among stroke survivors.

Source: Feasibility of Telerehabilitation in Stroke Recovery: A Survey on Access and Willingness to Use Low-Cost Consumer Technologies – Archives of Physical Medicine and Rehabilitation

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[Abstract] A Rehabilitation-Internet-of-Things in the Home to Augment Motor Skills and Exercise Training

Abstract

Although motor learning theory has led to evidence-based practices, few trials have revealed the superiority of one theory-based therapy over another after stroke. Nor have improvements in skills been as clinically robust as one might hope. We review some possible explanations, then potential technology-enabled solutions. Over the Internet, the type, quantity, and quality of practice and exercise in the home and community can be monitored remotely and feedback provided to optimize training frequency, intensity, and progression at home. A theory-driven foundation of synergistic interventions for walking, reaching and grasping, strengthening, and fitness could be provided by a bundle of home-based Rehabilitation Internet-of-Things (RIoT) devices. A RIoT might include wearable, activity-recognition sensors and instrumented rehabilitation devices with radio transmission to a smartphone or tablet to continuously measure repetitions, speed, accuracy, forces, and temporal spatial features of movement. Using telerehabilitation resources, a therapist would interpret the data and provide behavioral training for self-management via goal setting and instruction to increase compliance and long-term carryover. On top of this user-friendly, safe, and conceptually sound foundation to support more opportunity for practice, experimental interventions could be tested or additions and replacements made, perhaps drawing from virtual reality and gaming programs or robots. RIoT devices continuously measure the actual amount of quality practice; improvements and plateaus over time in strength, fitness, and skills; and activity and participation in home and community settings. Investigators may gain more control over some of the confounders of their trials and patients will have access to inexpensive therapies.

Source: A Rehabilitation-Internet-of-Things in the Home to Augment Motor Skills and Exercise Training

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[Abstract] The Present and Future of Robotic Technology in Rehabilitation – SpringerLink

Abstract

Robotic technology designed to assist rehabilitation can potentially increase the efficiency of, and accessibility to, therapy by assisting therapists to provide consistent training for extended periods of time, and collecting data to assess progress. Automatization of therapy may enable many patients to be treated simultaneously and possibly even remotely, in the comfort of their own homes, through telerehabilitation. The data collected can be used to objectively assess performance and document compliance as well as progress. All of these characteristics can make therapists more efficient in treating larger numbers of patients. Most importantly for the patient, it can increase access to therapy which is often in high demand and rationed severely in today’s fiscal climate. In recent years, many consumer-grade low-cost and off-the-shelf devices have been adopted for use in therapy sessions and methods for increasing motivation and engagement have been integrated with them. This review paper outlines the effort devoted to the development and integration of robotic technology for rehabilitation.

Source: The Present and Future of Robotic Technology in Rehabilitation | SpringerLink

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[Poster] Post-Stroke Reductions in Impairment and Functional Limitation Using a Telerehabilitation-Based Upper Extremity Protocol

To explore the feasibility and efficacy of remotely-delivered upper extremity (UE) therapy in a moderately impaired stroke survivor.

Source: Post-Stroke Reductions in Impairment and Functional Limitation Using a Telerehabilitation-Based Upper Extremity Protocol – Archives of Physical Medicine and Rehabilitation

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[Abstract] Scoping review of outcome measures used in telerehabilitation and virtual reality for post-stroke rehabilitation

Abstract

Introduction Despite the increased interest in telerehabilitation (TR), virtual reality (VR) and outcome measures for stroke rehabilitation, surprisingly little research has been done to map and identify the most common outcome measures used in TR. For this review, we conducted a systematic search of the literature that reports outcome measures used in TR or VR for stroke rehabilitation. Our specific objectives included: 1) to identify the outcome measures used in TR and VR studies; and 2) to describe which parts of the International Classification of Functioning are measured in the studies.

Methods We conducted a comprehensive search of relevant electronic databases (e.g. PubMed, the Cumulative Index to Nursing and Allied Health Literature, Embase, PSYCOINFO, The Cochrane Central Register of Controlled Trial and the Physiotherapy Evidence Database). The scoping review included all study designs. Two reviewers conducted pilot testing of the data extraction forms and independently screened all the studies and extracted the data. Disagreements about inclusion or exclusion were resolved by consensus or by consulting a third reviewer.

Results In total, 28 studies were included in this scoping review. The results were synthesized and reported considering the implications of the findings within the clinical practice and policy context.

Discussion This scoping review identified a wide range of outcome measures used in VR and TR studies and helped identify gaps in current use of outcome measures in the literature. The review also informs researchers and end users (i.e. clinicians, policymakers and researchers) regarding the most appropriate outcome measures for TR or VR.

Source: Scoping review of outcome measures used in telerehabilitation and virtual reality for post-stroke rehabilitation

 

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[ARTICLE] Effects of physical therapy delivery via home video telerehabilitation on functional and health-related quality of life outcomes – Full Text HTML

Abstract 

This study examined functional outcomes, health-related quality of life (HRQoL), and satisfaction in a group of Veterans who received physical therapy via an in-home video telerehabilitation program, the Rural Veterans TeleRehabilitation Initiative (RVTRI). A retrospective, pre–post study design was used. Measures obtained from 26 Veterans who received physical therapy in the RVTRI program between February 22, 2010, and April 1, 2011, were analyzed. Outcomes were the Functional Independence Measure (FIM); Quick Disabilities of the Arm, Shoulder, and Hand measure; Montreal Cognitive Assessment (MoCA); and the 2-minute walk test (2MWT). HRQoL was assessed using the Veterans RAND 12-Item Health Survey (VR-12), and program satisfaction was evaluated using a telehealth satisfaction scale. Average length of participation was 99.2 +/– 43.3 d and Veterans, on average, received 15.2 +/– 6.0 therapeutic sessions. Significant improvement was shown in the participants’ FIM (p < 0.001, r = 0.63), MoCA (p = 0.01, r= 0.44), 2MWT (p = 0.006, r = 0.73), and VR-12 (p = 0.02, r = 0.42). All Veterans reported satisfaction with their telerehabilitation experiences. Those enrolled in the RVTRI program avoided an average of 2,774.7 +/– 3,197.4 travel miles, 46.3 +/– 53.3 hr of driving time, and $1,151.50 +/– $1,326.90 in travel reimbursement. RVTRI provided an effective real-time, home-based, physical therapy.

INTRODUCTION

The mission of the Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) is to deliver uniform high-quality care to all Veterans, regardless of geography, distance, or economic circumstances. To meet this mission, the VHA must reach Veterans regardless of barriers to care provision, including long travel times and distances and expense. These barriers are magnified for rural Veterans with disabilities who require rehabilitation services. These individuals must invest additional time, thought, and resources in order to reach distant medical centers. Many rehabilitation protocols involve repeated therapy sessions, often two to five times weekly over weeks or months, resulting in additional physical, financial, and logistical hardships. In order to fulfill its promise, the VHA is actively attempting to address the gap in services for Veterans with limited access to traditional modes of treatment.

The VHA presently serves 3.3 million Veterans residing in rural localities. These individuals represent 41 percent of all Veterans enrolled in the VHA. Nearly 43 percent (2.27 million) of Veterans served by the VHA with a service-­connected disability live in rural or highly rural areas [1]. Therefore, the VHA is looking to new technologies to facilitate access to healthcare for these individuals. As stated by W. Scott Gould, the former U.S. Deputy Secretary of Veterans Affairs, “We are investing more in telehealth technologies to make VA healthcare available to Veterans wherever they live. In FY [fiscal year] 2010, we invested $121 million in telehealth. In FY2011, those investments will grow to $163 million. By the end of FY2012, we expect to have doubled our present use of telehealth” [2]. Robert A. Petzel, the former Under Secretary for Health of the VA, has explicitly endorsed home telehealth technologies. In testimony before the House Committee on Veterans’ Health on February 23, 2010, he stated, “Our increasing reliance on noninstitutional long-term care includes an investment in 2011 of $163 million in home telehealth. Taking greater advantage of the latest technological advancements in healthcare delivery will allow us to more closely monitor the health status of Veterans and will greatly improve access to care. Telehealth will place specialized healthcare professionals in direct contact with patients using modern IT [information technology] tools” [3].

Telerehabilitation refers to the clinical application of consultative, preventative, diagnostic, and therapeutic services via two-way interactive telecommunication technologies [4–5]. Telerehabilitation is an alternative to usual-care outpatient rehabilitation services. It can also serve as an alternative to “homecare” rehabilitation, which requires the treating therapist or clinician to travel to the patient’s home. By reducing or eliminating barriers relating to travel time and travel-related costs, telerehabilitation has the potential to improve access to rehabilitative care for stroke survivors [6–7]. Improving access to rehabilitative care may reduce disparities for stroke survivors and caregivers facing financial or transportation-related challenges. While research on telerehabilitation is limited, there is increasing evidence supporting the need for telerehabilitation services, the development of telerehabilitation interventions, and support for people with disabling conditions that potentially limit access to rehabilitation services [6–14].

The emerging field of video-based telerehabilitation allows therapists to deliver rehabilitative care to Veterans with physical, financial, and logistical barriers to healthcare providers and facilities [5]. Telerehabilitation has expanded dramatically in recent years as a result of advances in technology, increases in speed of telecommunication, and decreases in costs of computer hardware and software [6]. The scope of telerehabilitation includes direct therapeutic interventions, disease monitoring, coordination of care, patient and caregiver training and education, patient networking, and multidisciplinary professional consultation [15–16].

Veteran access to healthcare services is a topic of high interest and concern to both providers and researchers [6,17–20]. Numerous factors may interfere with patient access to healthcare, including distance, high travel-related expenses, reduced numbers of healthcare providers within rural areas, transportation barriers, caregiver burden, attitude toward and perception of medical care providers, consumer knowledge, informal caregiver and/or familial supports, and ethnic and cultural differences. Reduced access to healthcare contributes to increased morbidity and mortality, increased cost of treatment, and inappropriate use of emergency services [21–24]. Available technologies allow for rehabilitative services to be provided in real-time from providers’ clinics to various recipients’ locations such as home, community, health facilities, and/or work settings. While popular enthusiasm and capital investment in telerehabilitation continue to grow, very little is known regarding the efficacy of telerehabilitation or patients’ overall evaluation and acceptance of telerehabilitation services [25]. A recent Cochran review concerning telerehabilitation services provided to patients during recovery from stroke concluded that sufficient data do not exist to support the effectiveness of telerehabilitation as a stand-alone replacement for traditional rehabilitative services for the restoration of activities of daily living, mobility, upper-limb function, health-related quality of life (HRQoL), patient satisfaction, or cost savings for patients receiving rehabilitative care following stroke [5]. The purpose of this study was to assess the functional outcomes, HRQoL, and satisfaction of a group of patients who participated in a VA telerehabilitation program.

 

Continue —> Effects of physical therapy delivery via home video telerehabilitation on functional and health-related quality of life outcomes

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