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Posts Tagged Virtual rehabilitation
Elizabeth Hofheinz, M.P.H., M.Ed. • Tue, October 23rd, 2018
San Diego, California-based Reflexion Health, Inc., in conjunction with the Duke Clinical Research Institute in Durham, North Carolina, has announced positive results from a (as yet unpublished) randomized controlled clinical trial, “Virtual Exercise Rehabilitation In-home Therapy: A Research Study (VERITAS).”
The trial was designed to evaluate the cost and clinical non-inferiority of using a virtual rehabilitation platform to deliver physical therapy following total knee replacement surgery.
“Physical therapy is a critical component of recovery for patients following total joint replacement surgery. As people live longer and these surgeries become more common, it is important to identify solutions that maintain or improve outcomes while decreasing the burden on patients and providers,” said Janet Prvu Bettger, Ph.D., associate professor with the Duke Department of Orthopedic Surgery and principal investigator of the study.
According to Reflexion Health, “VERITAS was a multi-center, randomized controlled trial that enrolled 306 adult participants scheduled for knee replacement surgery at four U.S. sites. Of the consented participants, 287 completed the trial. The treatment group concluded with 143 adults who received Reflexion Health’s VERA [Virtual Exercise Rehabilitation Assistant] both pre- and post-surgery, compared with a control group of 144 adults who received traditional in-home or clinic-based physical therapy at participating sites. Clinical outcomes, health service use, and costs were examined for three months after surgery.”
“The study results demonstrated an average cost savings of $2,745 per patient for those who received virtual physical therapy using VERA technology with clinical oversight when compared to usual care with traditional physical therapy. Virtual physical therapy met its secondary effectiveness endpoints of non-inferiority for reducing disability and improving knee function. Compared with usual care, safety endpoints for patients with virtual physical therapy were similar.”
“VERITAS provides the highest level of evidence that VERA is a more cost-effective, patient-centered alternative to traditional care,” said Joseph Smith, M.D., Ph.D., chief executive officer of ReflexionHealth.“The strength of these results should give providers and payors the proof they need to adopt VERA. Engaging and delighting patients with a convenient and connected solution in the comfort of their own home, while providing similar or better clinical outcomes and dramatically reducing overall healthcare costs is a win for everyone.”
Dr. Smith told OTW, “The first development milestone was proof of concept—proving that all patients could use it (usability) and that the feedback to each patient about their exercises was appropriate. The second milestone was that use of VERA improved compliance/adherence while delighting patients. The final milestones (as proven in the VERITAS trial) were that overall outcomes were at least as good as standard of care while the costs to everyone were much lower.”
“For busy clinicians, VERA provides unprecedented and efficient visibility into the patient’s post-operative recovery while greatly diminishing the overall cost of post-surgical rehabilitation.”
“For patients, VERA provides convenience, dramatically enhanced compliance, the comfort of an on-demand, at-home solution, and cost-savings from avoided travel and co-pays—and they love it!”
[Abstract + References] A Scoping Study on the Development of an Interactive Upper-Limb Rehabilitation System Framework for Patients with Stroke – Conference paper
This study aims to propose the framework of the interactive upper-limb rehabilitation system with brain-computer interfaces. The system mainly includes an interactive rehabilitation training platform, a rehabilitation database system, and an EEG and EMG acquisition system. The interactive rehabilitation training system platform includes a virtual rehabilitation game system and an interactive upper-limb rehabilitation device by which a user can perform proactive and reactive rehabilitation.
[Abstract] A low cost kinect-based virtual rehabilitation system for inpatient rehabilitation of the upper limb in patients with subacute stroke: A randomized, double-blind, sham-controlled pilot trial.
We designed this study to prove the efficacy of the low-cost Kinect-based virtual rehabilitation (VR) system for upper limb recovery among patients with subacute stroke.
A double-blind, randomized, sham-controlled trial was performed. A total of 23 subjects with subacute stroke (<3 months) were allocated to sham (n = 11) and real VR group (n = 12). Both groups participated in a daily 30-minute occupational therapy for upper limb recovery for 10 consecutive weekdays. Subjects received an additional daily 30-minute Kinect-based or sham VR. Assessment was performed before the VR, immediately and 1 month after the last session of VR. Fugl-Meyer Assessment (FMA) (primary outcome) and other secondary functional outcomes were measured. Accelerometers were used to measure hemiparetic upper limb movements during the therapy.
FMA immediately after last VR session was not different between the sham (46.8 ± 16.0) and the real VR group (49.4 ± 14.2) (P = .937 in intention to treat analysis). Significant differences of total activity counts (TAC) were found in hemiparetic upper limb during the therapy between groups (F2,26 = 4.43; P = .22). Real VR group (107,926 ± 68,874) showed significantly more TACs compared with the sham VR group (46,686 ± 25,814) but there was no statistical significance between real VR and control (64,575 ± 27,533).
Low-cost Kinect-based upper limb rehabilitation system was not more efficacious compared with sham VR. However, the compliance in VR was good and VR system induced more arm motion than control and similar activity compared with the conventional therapy, which suggests its utility as an adjuvant additional therapy during inpatient stroke rehabilitation.
- PMID:29924029 DOI:10.1097/MD.0000000000011173
[BOOK] Emerging Therapies in Neurorehabilitation II – [Chapter] Virtual Rehabilitation – Request PDF
Virtual Rehabilitation | Request PDF. Available from: https://www.researchgate.net/publication/300324828_Virtual_Rehabilitation
Rehabilitation technology leader Tyromotion has developed a rehabilitation device that combines virtual reality with robotic therapy to make stroke rehabilitation faster and more efficient.
Tyromotion has created a rehabilitation device that uses a bilateral 3D arm robot and virtual reality glasses to fully immerse stroke patients in virtual worlds where both the visual and physical environments can be shaped. The device is designed to help patients with limited arm function perform daily tasks by challenging and encouraging them to increase their range of motion and the number of repetitions during their therapy sessions. Both these elements are vital to motor learning.
The introduction of virtual reality into therapy delivers a 3D training environment that can be adapted to each individual patient’s abilities. The virtual setting has a gaming element to it, which helps motivate patients to keep repeating their exercises.
Tyromotion’s device is currently being tested by leading rehabilitation facilities in Europe and the United States. The initial reports from therapists and doctors have been very positive, indicating that the new approach to therapy has a strong potential to transform it by increasing patient motivation and making therapy programs more cost effective across the board.
Diego, the robot-assisted arm rehabilitation device used to deliver VR therapy, is the world’s most versatile arm-shoulder rehabilitation device, one that combines robotics with intelligent gravity compensation (IGC) and virtual reality to help patients regain lost arm function. The device offers passive, active and assistive, uni- and bilateral applications that are easily adapted to meet the needs of each patient.
The gravity compensation feature makes heavy arms lighter, allowing physiological movement of the arms in every phase of rehabilitation. The device gives patients more room and more freedom to move and is particularly well suited for task-oriented training with real objects.
Diego offers a versatile range of therapy options with interactive therapy modules that provide haptic and audiovisual feedback, immersing patients in motion in the virtual environment. The therapy modules have different levels of difficulty, which motivates patients to keep making progress. Their progress is then recorded to make their achievements visible.
Diego is suitable for patients of all ages and can be used in all phases of arm rehabilitation. Watch the video below to learn more about its features and benefits.
[ARTICLE] USEQ: A Short Questionnaire for Satisfaction Evaluation of Virtual Rehabilitation Systems – Full Text HTML
New emerging technologies have proven their efficacy in aiding people in their rehabilitation. The tests that are usually used to evaluate usability (in general) or user satisfaction (in particular) of this technology are not specifically focused on virtual rehabilitation and patients. The objective of this contribution is to present and evaluate the USEQ (User Satisfaction Evaluation Questionnaire). The USEQ is a questionnaire that is designed to properly evaluate the satisfaction of the user (which constitutes part of usability) in virtual rehabilitation systems. Forty patients with balance disorders completed the USEQ after their first session with ABAR (Active Balance Rehabilitation), which is a virtual rehabilitation system that is designed for the rehabilitation of balance disorders. Internal consistency analysis and exploratory factor analysis were carried out to identify the factor structure of the USEQ. The six items of USEQ were significantly associated with each other, and the Cronbach alpha coefficient for the questionnaire was 0.716. In an analysis of the principal components, a one-factor solution was considered to be appropriate. The findings of the study suggest that the USEQ is a reliable questionnaire with adequate internal consistency. With regard to patient perception, the patients found the USEQ to be an easy-to-understand questionnaire with a convenient number of questions.
2. USEQ: The User Satisfaction Evaluation Questionnaire
2.1. SEQ: The Suitability Evaluation Questionnaire
[Thesis] Exploring In-Home Monitoring of Rehabilitation and Creating an Authoring Tool for Physical Therapists – Full Text PDF
Physiotherapy is a key part of treatment for neurological and musculoskeletal disorders, which affect millions in the U.S. each year. Physical therapy treatments typically consist of an initial diagnostic session during which patients’ impairments are assessed and exercises are prescribed to improve the impaired functions. As part of the treatment program, exercises are often assigned to be performed at home daily. Patients return to the clinic weekly or biweekly for check-up visits during which the physical therapist reassesses their condition and makes further treatment decisions, including readjusting the exercise prescriptions.
Most physical therapists work in clinics or hospitals. When patients perform their exercises at home, physical therapists cannot supervise them and lack quantitative exercise data reflecting the patients’ exercise compliance and performance. Without this information, it is difficult for physical therapists to make informed decisions or treatment adjustments. To make informed decisions, physical therapists need to know how often patients exercise, the duration and/or repetitions of each session, exercise metrics such as the average velocities and ranges of motion for each exercise, patients’ symptom levels (e.g. pain or dizziness) before and after exercise, and what mistakes patients make.
In this thesis, I evaluate and work towards a solution to this problem. The growing ubiquity of mobile and wearable technology makes possible the development of “virtual rehabilitation assistants.” Using motion sensors such as accelerometers and gyroscopes that are embedded in a wearable device, the “assistant” can mediate between patients at home and physical therapists in the clinic. Its functions are to:
- use motion sensors to record home exercise metrics for compliance and performance and report these metrics to physical therapists in real-time or periodically;
- allow physical therapists and patients to quantify and see progress on a fine-grain level;
- record symptom levels to further help physical therapists gauge the effectiveness of exercise prescriptions;
- offer real-time mistake recognition and feedback to the patients during exercises;
One contribution of this thesis is an evaluation of the feasibility of this idea in real home settings. Because there has been little research on wearable virtual assistants in patient homes, there are many unanswered questions regarding their use and usefulness:
- Q1. What patient in-home data could wearable virtual assistants gather to support physical therapy treatments?
- Q2. Can patient data gathered by virtual assistants be useful to physical therapists?
- Q3. How is this wearable in-home technology received by patients?
I sought to answer these questions by implementing and deploying a prototype called “SenseCap.” SenseCap is a small mobile device worn on a ball cap that monitors patients’ exercise movements and queries them about their symptoms. A technology probe study showed that the virtual assistant could gather important compliance, performance, and symptom data to assist physical therapists’ decision-making, and that this technology would be feasible and acceptable for in-home use by patients.
Another contribution of this thesis is the development of a tool to allow physical therapists to create and customize virtual assistants. With current technology, virtual assistants require engineering and programming efforts to design, implement, configure and deploy them. Because most physical therapists do not have access to an engineering team they and their patients would be unable to benefit from this technology. With the goal of making virtual assistants accessible to any physical therapist, I explored the following research questions:
- Q4. Would a user-friendly rule-specification interface make it easy for physical therapists to specify correct and incorrect exercise movements directly to a computer? What are the limitations of this method of specifying exercise rules?
- Q5. Is it possible to create a CAD-type authoring tool, based on a usable interface, that physical therapists could use to create their own customized virtual assistant for monitoring and coaching patients? What are the implementation details of such a system and the resulting virtual assistant?
- Q6. What preferences do PTs have regarding the delivery of coaching feedback for patients?
- Q7. What is the recognition accuracy of a virtual rehabilitation assistant created by this tool?
This dissertation research aims to improve our understanding of the barriers to rehabilitation that occur because of the invisibility of home exercise behavior, to lower these barriers by making it possible for patients to use a widely-available and easily-used wearable device that coaches and monitors them while they perform their exercises, and improve the ability of physical therapists to create an exercise regime for their patients and to learn what patients have done to perform these exercises. In doing so, treatment should be better suited to each patient and more successful.
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[ARTICLE] Virtual rehabilitation via Nintendo Wii® and conventional physical therapy effectively treat post-stroke hemiparetic patients
Background: The Nintendo® Wii is a simple and affordable virtual therapy alternative. It may be used at home, and it is a motivating recreational activity that provides continuous feedback. However, studies comparing the use of the Nintendo® Wii to conventional physical therapy are needed.
Objective: To compare the effect of a rehabilitation treatment using the Nintendo® Wii (NW) with conventional physical therapy (CPT) to improve the sensorimotor function and quality of life for post-stroke hemiparetic patients.
Methods: The present study applied a randomized, blind, and controlled clinical trial. In total, 30 patients with post-stroke hemiparesis were evaluated. A total of 15 patients were randomly assigned to each group. The SF-36 quality of life and Fugl–Meyer scales were used to evaluate the patients.
Results: After treatment, the only variable that differed between the groups was the physical functioning domain of the SF-36 in the group that received conventional physical therapy. A significant difference was observed between both groups before and after treatment in terms of the following Fugl–Meyer scale items: passive movement and pain, motor function of the upper limbs (ULs), and balance. The CPT group also showed a significant difference with regard to their UL and lower limb (LL) coordination. The SF-36 scale analysis revealed a significant difference within both groups with regard to the following domains: physical functioning, role limitation due to physical aspects, vitality, and role limitation due to emotional aspects. The NW group also exhibited a significant difference in the mental health domain. The results indicate that both approaches improved the patients’ performance in a similar manner.
Conclusion: Virtual rehabilitation using the Nintendo Wii® and CPT both effectively treat post-stroke hemiparetic patients by improving passive movement and pain scores, motor function of the upper limb, balance, physical functioning, vitality, and the physical and emotional aspects of role functioning.