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Willingham TB, Stowell J, Collier G, Backus D. Leveraging Emerging Technologies to Expand Accessibility and Improve Precision in Rehabilitation and Exercise for People with Disabilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:79. [PMID: 38248542 PMCID: PMC10815484 DOI: 10.3390/ijerph21010079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024]
Abstract
Physical rehabilitation and exercise training have emerged as promising solutions for improving health, restoring function, and preserving quality of life in populations that face disparate health challenges related to disability. Despite the immense potential for rehabilitation and exercise to help people with disabilities live longer, healthier, and more independent lives, people with disabilities can experience physical, psychosocial, environmental, and economic barriers that limit their ability to participate in rehabilitation, exercise, and other physical activities. Together, these barriers contribute to health inequities in people with disabilities, by disproportionately limiting their ability to participate in health-promoting physical activities, relative to people without disabilities. Therefore, there is great need for research and innovation focusing on the development of strategies to expand accessibility and promote participation in rehabilitation and exercise programs for people with disabilities. Here, we discuss how cutting-edge technologies related to telecommunications, wearables, virtual and augmented reality, artificial intelligence, and cloud computing are providing new opportunities to improve accessibility in rehabilitation and exercise for people with disabilities. In addition, we highlight new frontiers in digital health technology and emerging lines of scientific research that will shape the future of precision care strategies for people with disabilities.
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Affiliation(s)
- T. Bradley Willingham
- Shepherd Center, Virginia C. Crawford Research Institute, Atlanta, GA 30309, USA (D.B.)
- Department of Physical Therapy, Georgia State University, Atlanta, GA 30302, USA
| | - Julie Stowell
- Shepherd Center, Virginia C. Crawford Research Institute, Atlanta, GA 30309, USA (D.B.)
- Department of Physical Therapy, Georgia State University, Atlanta, GA 30302, USA
| | - George Collier
- Shepherd Center, Virginia C. Crawford Research Institute, Atlanta, GA 30309, USA (D.B.)
| | - Deborah Backus
- Shepherd Center, Virginia C. Crawford Research Institute, Atlanta, GA 30309, USA (D.B.)
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Zolfagharzadeh H, Esfandiari M, Taheri Otaghsara SM, Mohebbi A, Emami Zeydi A, Zare-Kaseb A, Ghazanfari MJ. How to manage ongoing post-discharge challenges of burn survivors. Burns 2023; 49:1229-1230. [PMID: 36737379 DOI: 10.1016/j.burns.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023]
Affiliation(s)
- Hadi Zolfagharzadeh
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Islamic Azad University, Urmia, Iran
| | - Mostafa Esfandiari
- Department of Medical-Surgical Nursing, Nasibeh School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyedeh Mahjabin Taheri Otaghsara
- Department of Medical-Surgical Nursing, Nasibeh School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Alireza Mohebbi
- Department of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Amir Emami Zeydi
- Department of Medical-Surgical Nursing, Nasibeh School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Akbar Zare-Kaseb
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Ghazanfari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Surface Electromyography-Driven Therapeutic Gaming for Rehabilitation of Upper Extremity Weakness: A Pilot Study. Plast Reconstr Surg 2022; 150:125-131. [PMID: 35544314 DOI: 10.1097/prs.0000000000009208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
SUMMARY In patients with severe upper extremity weakness that may result from peripheral nerve injuries, stroke, and spinal cord injuries, standard therapy in the earliest stages of recovery consists primarily of passive rather than active exercises. Adherence to prescribed therapy may be poor, which may contribute to suboptimal functional outcomes. The authors have developed and integrated a custom surface electromyography device with a video game to create an interactive, biofeedback-based therapeutic gaming platform. Sensitivity of the authors' custom surface electromyography device was evaluated with simultaneous needle electromyography recordings. Testing of this therapeutic gaming platform was conducted with a single 30-minute gameplay session in 19 patients with a history of peripheral nerve injury, stroke, spinal cord injury, and direct upper extremity trauma, including 11 patients who had undergone nerve and/or tendon transfers. The device was highly sensitive in detecting low levels of voluntary muscle activation and was used with 10 distinct muscles of the arm, forearm, and hand. Nerve and tendon transfer patients successfully activated the donor nerve/muscle and elicited the desired movement to engage in gameplay. On surveys of acceptability and usability, patients felt the system was enjoyable, motivating, fun, and easy to use, and their hand therapists expressed similar enthusiasm. Surface electromyography-based therapeutic gaming is a promising approach to rehabilitation that warrants further development and investigation to examine its potential efficacy, not only for building muscle strength and endurance but also for facilitating motor relearning after nerve and tendon transfer surgical procedures. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Tsiouris KM, Tsakanikas VD, Gatsios D, Fotiadis DI. A Review of Virtual Coaching Systems in Healthcare: Closing the Loop With Real-Time Feedback. Front Digit Health 2021; 2:567502. [PMID: 34713040 PMCID: PMC8522109 DOI: 10.3389/fdgth.2020.567502] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/28/2020] [Indexed: 12/04/2022] Open
Abstract
This review focuses on virtual coaching systems that were designed to enhance healthcare interventions, combining the available sensing and system-user interaction technologies. In total, more than 1,200 research papers have been retrieved and evaluated for the purposes of this review, which were obtained from three online databases (i.e.,PubMed, Scopus and IEEE Xplore) using an extensive set of search keywords. After applying exclusion criteria, the remaining 41 research papers were used to evaluate the status of virtual coaching systems over the past 10 years and assess current and future trends in this field. The results suggest that in home coaching systems were mainly focused in promoting physical activity and a healthier lifestyle, while a wider range of medical domains was considered in systems that were evaluated in lab environment. In home patient monitoring with IoT devices and sensors was mostly limited to activity trackers, pedometers and heart rate monitoring. Real-time evaluations and personalized patient feedback was also found to be rather lacking in home coaching systems and this is the most alarming find of this analysis. Feasibility studies in controlled environment and an ongoing active research on Horizon 2020 funded projects, show that the future trends in this field are aiming to close the loop with automated patient monitoring, real-time evaluations and more precise interventions.
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Affiliation(s)
- Kostas M Tsiouris
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece.,Unit of Medical Technology and Intelligent Information Systems, Department of Material Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Vassilios D Tsakanikas
- Unit of Medical Technology and Intelligent Information Systems, Department of Material Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Dimitrios Gatsios
- Unit of Medical Technology and Intelligent Information Systems, Department of Material Science and Engineering, University of Ioannina, Ioannina, Greece.,Department of Neurology, Medical School, University of Ioannina, Ioannina, Greece
| | - Dimitrios I Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Department of Material Science and Engineering, University of Ioannina, Ioannina, Greece.,Department of Biomedical Research, Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology - Hellas, Ioannina, Greece
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Assad-Uz-Zaman M, Islam MR, Rahman MH, Wang YC, McGonigle E. Kinect Controlled NAO Robot for Telerehabilitation. JOURNAL OF INTELLIGENT SYSTEMS 2020. [DOI: 10.1515/jisys-2019-0126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
In this paper, we focus on the human upper limb rehabilitation scheme that utilizes the concept ofteleoperation. Teleoperation can help the therapist demonstrate different rehab exercises to a different group of people at the same time remotely. Different groups of people from a different place connected to the same network can get therapy from the same therapist at the same time using the telerehabilitation scheme. Here, we presented a humanoid robot NAO that can be operated remotely by a therapist to demonstrate the exercise to a patient. To mimic the movement demonstrated by the therapist, Kinect V2 sensor which is a markerless vision-based motion-tracking device, was used. Modified Denavit-Hartenberg (DH) convention was used for the kinematic modeling of the human upper arm. From the Kinect data, a geometric solution was developed to find a unique inverse kinematic solution of human upper-extremity. Experimental results revealed that NAO could be teleoperated successfully to instruct and demonstrate patients to perform different arm movement exercises in real-time.
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Affiliation(s)
- Md Assad-Uz-Zaman
- University of Wisconsin Milwaukee – Mechanical Engineering , Milwaukee , Wisconsin , United States of America
| | - Md Rasedul Islam
- Rasedul, University of Wisconsin Milwaukee – Mechanical engineering , Milwaukee , Wisconsin , United States of America
| | - Mohammad Habibur Rahman
- University of Wisconsin Milwaukee – Mechanical Engineering , Milwaukee , Wisconsin , United States of America
| | - Ying-Chih Wang
- University of Wisconsin Milwaukee – Department of Occupational Science & Technology , Milwaukee , Wisconsin , United States of America
| | - Erin McGonigle
- Medical College of Wisconsin– Department of Physical Medicine & Rehabilitation , Milwaukee , Wisconsin , United States of America
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Parke S, Hough CL, E Bunnell A. The Feasibility and Acceptability of Virtual Therapy Environments for Early ICU Mobilization. PM R 2020; 12:1214-1221. [PMID: 32107863 DOI: 10.1002/pmrj.12352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 02/04/2020] [Accepted: 02/14/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Early mobilization in critically ill patients has been documented to reduce neuromuscular complications, but access to rehabilitation services is often limited in the intensive care unit (ICU). Virtual platforms that deliver therapy may increase access to rehabilitation services and improve patient motivation to participate. Xbox Kinect Jintronix software delivers interventions using games and activities designed for therapy. OBJECTIVE To determine the feasibility of the Jintronix virtual therapy system in an ICU setting by observing outcomes related to patient satisfaction, adverse events, and technical applicability. DESIGN Prospective observational feasibility study. SETTING Medical ICU at a Level 1 Trauma Center within an academic medical center. PARTICIPANTS Twenty adults admitted to ICU. INTERVENTION Participants engaged in one therapy session with a maximum of 14 Jintronix modules targeting arm, leg, and/or trunk strength, range of motion, and endurance. OUTCOME MEASURES A trained physician-observer recorded events related to adverse events and technical applicability. Participants completed a survey to determine patient satisfaction. RESULTS A total of 188 modules were completed. Participants completed a median of nine modules each. Five participants completed the maximum of 14 modules. Fatigue was the most common reason for cessation. Mean intervention time was 29 minutes. There were no falls, lines dislodged, or medical events. Participants required physical assistance or verbal cues in 36% of modules. Technical errors affected 25% of modules and led to activity cessation in one case. Nearly all participants reported the activity was enjoyable, comfortable, safe, easy to understand, would improve range of motion and strength, and would motivate them to continue. CONCLUSIONS Use of a virtual therapy environment in an intensive care setting is feasible.
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Affiliation(s)
- Sara Parke
- Department of Rehabilitation Medicine, Department of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Catherine L Hough
- Department of Rehabilitation Medicine, Department of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Aaron E Bunnell
- Department of Rehabilitation Medicine, Department of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA
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Pham TN, Goldstein R, Carrougher GJ, Gibran NS, Goverman J, Esselman PC, Kazis LE, Ryan CM, Schneider JC. The impact of discharge contracture on return to work after burn injury: A Burn Model System investigation. Burns 2020; 46:539-545. [PMID: 32088093 DOI: 10.1016/j.burns.2020.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/22/2020] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Despite many advances in burn care, the development of extremity contracture remains a common and vexing problem. Extremity contractures have been documented in up to one third of severely burned patients at discharge. However, little is known about the long-term impact of these contractures. The purpose of this study was to examine the association of extremity contractures with employment after burn injury. METHODS We obtained data from the Burn Model System database from 1994 to 2003. We included in the study cohort all adult patients who were working prior to injury and identified those discharged with and without a contracture in one of the major extremity joints (shoulder, elbow, wrist, hip, knee and ankle). We classified contracture severity according to mild, moderate and severe categories. We performed descriptive analyses and predictive modeling to identify injury and patient factors associated with return to work (RTW) at 6, 12, and 24 months. RESULTS A total of 1,203 participant records met criteria for study inclusion. Of these, 415 (35%) had developed a contracture at discharge; 9% mild, 12% moderate, and 14% severe. Among 801 (67%) participants who had complete data at 6 months after discharge, 70% of patients without contracture had returned to work compared to 45% of patients with contractures (p < 0.001). RTW increased at each subsequent follow-up time point for the contracture group, however, it remained significantly lower than in no-contracture group (both p < 0.01). In multivariable analyses, female sex, non-Caucasian ethnicity, larger burn size, alcohol abuse, number of in-hospital operations, amputation, and in-hospital complications were associated with a lower likelihood of employment. In adjusted analyses, discharge contracture was associated with a lower probability of RTW at all 3 time points, although its impact significantly diminished at 24 months. CONCLUSIONS This study indicates an association between discharge contracture and reduced employment 6, 12 and 24 months after burn injury. Among many other identified patient, injury, and hospitalization related factors that are barriers to RTW, the presence of a contracture at discharge adds a significant reintegration burden for working-age burn patients.
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Affiliation(s)
- Tam N Pham
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, United States.
| | - Richard Goldstein
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, United States
| | - Gretchen J Carrougher
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, United States
| | - Nicole S Gibran
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, United States
| | - Jeremy Goverman
- Shriners Hospitals for Children-Boston, Department of Surgery, Harvard Medical School, United States
| | - Peter C Esselman
- Department of Rehabilitation Medicine, University of Washington, United States
| | - Lewis E Kazis
- Department of Health Law and Policy and Management, Boston University School of Public Health, United States
| | - Colleen M Ryan
- Shriners Hospitals for Children-Boston, Department of Surgery, Harvard Medical School, United States
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, United States
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