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Zampolini M, Oral A, Barotsis N, Aguiar Branco C, Burger H, Capodaglio P, Dincer F, Giustini A, Hu X, Irgens I, Negrini S, Tederko P, Treger I, Kiekens C. Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice on telerehabilitation. The European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med 2024; 60:165-181. [PMID: 38477069 PMCID: PMC11135123 DOI: 10.23736/s1973-9087.24.08396-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 01/29/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION The evidence on the utility and effectiveness of rehabilitation interventions delivered via telerehabilitation is growing rapidly. Telerehabilitation is expected to have a key role in rehabilitation in the future. AIM The aim of this evidence-based position paper (EBPP) is to improve PRM physicians' professional practice in telerehabilitation to be delivered to improve functioning and to reduce activity limitations and/or participation restrictions in individuals with a variety of disabling health conditions. METHODS To produce recommendations for PRM physicians on telerehabilitation, a systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. RESULTS The systematic literature review is reported together with the 32 recommendations resulting from the Delphi procedure. CONCLUSIONS It is recommended that PRM physicians deliver rehabilitation services remotely, via digital means or using communication technologies to eligible individuals, whenever required and feasible in a variety of health conditions in favor of the patient and his/her family, based on evidence of effectiveness and in compliance with relevant regulations. This EBPP represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians in telerehabilitation.
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Affiliation(s)
| | - Aydan Oral
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye -
| | | | - Catarina Aguiar Branco
- Department of Physical and Rehabilitation Medicine, Hospital of Entre o Douro e Vouga E.P.E., Porto, Portugal
- Faculty of Dentistry, University of Porto, Porto, Portugal
| | - Helena Burger
- University Rehabilitation Institute of the Republic of Slovenia, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Paolo Capodaglio
- Orthopedic Rehabilitation Unit and Research Lab in Biomechanics, Rehabilitation and Ergonomics, San Giuseppe Hospital, Istituto Auxologico Italiano, IRCCS, Verbania, Italy
- Department of Surgical Sciences, Physical and Rehabilitation Medicine, University of Turin, Turin, Italy
| | - Fitnat Dincer
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | | | - Xiaolei Hu
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Ingebjorg Irgens
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Piotr Tederko
- Department of Rehabilitation, Center of Postgraduate Medical Education, Otwock, Poland
| | - Iuly Treger
- Department of Rehabilitation, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Khan MN, Altalbe A, Naseer F, Awais Q. Telehealth-Enabled In-Home Elbow Rehabilitation for Brachial Plexus Injuries Using Deep-Reinforcement-Learning-Assisted Telepresence Robots. SENSORS (BASEL, SWITZERLAND) 2024; 24:1273. [PMID: 38400431 PMCID: PMC10892919 DOI: 10.3390/s24041273] [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: 12/19/2023] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024]
Abstract
Due to damage to the network of nerves that regulate the muscles and feeling in the shoulder, arm, and forearm, brachial plexus injuries (BPIs) are known to significantly reduce the function and quality of life of affected persons. According to the World Health Organization (WHO), a considerable share of global disability-adjusted life years (DALYs) is attributable to upper limb injuries, including BPIs. Telehealth can improve access concerns for patients with BPIs, particularly in lower-middle-income nations. This study used deep reinforcement learning (DRL)-assisted telepresence robots, specifically the deep deterministic policy gradient (DDPG) algorithm, to provide in-home elbow rehabilitation with elbow flexion exercises for BPI patients. The telepresence robots were used for a six-month deployment period, and DDPG drove the DRL architecture to maximize patient-centric exercises with its robotic arm. Compared to conventional rehabilitation techniques, patients demonstrated an average increase of 4.7% in force exertion and a 5.2% improvement in range of motion (ROM) with the assistance of the telepresence robot arm. According to the findings of this study, telepresence robots are a valuable and practical method for BPI patients' at-home rehabilitation. This technology paves the way for further research and development in telerehabilitation and can be crucial in addressing broader physical rehabilitation challenges.
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Affiliation(s)
- Muhammad Nasir Khan
- Electrical Engineering Department, Government College University Lahore, Lahore 54000, Pakistan
| | - Ali Altalbe
- Department of Computer Engineering, Prince Sattam bin Abdulaziz University, Alkharj 11942, Saudi Arabia
- Faculty of Computing and Information Technology, King Abdulaziz University, P.O. Box 80210, Jeddah 21589, Saudi Arabia
| | - Fawad Naseer
- Computer Science and Software Engineering Department, Beaconhouse International College, Faisalabad 38000, Pakistan;
| | - Qasim Awais
- Electrical Engineering Department, Fatima Jinnah Women University, Rawalpindi 46000, Pakistan;
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Maggio MG, Baglio F, Arcuri F, Borgnis F, Contrada M, Diaz MDM, Leochico CF, Neira NJ, Laratta S, Suchan B, Tonin P, Calabrò RS. Cognitive telerehabilitation: an expert consensus paper on current evidence and future perspective. Front Neurol 2024; 15:1338873. [PMID: 38426164 PMCID: PMC10902044 DOI: 10.3389/fneur.2024.1338873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024] Open
Abstract
The progressive improvement of the living conditions and medical care of the population in industrialized countries has led to improvement in healthcare interventions, including rehabilitation. From this perspective, Telerehabilitation (TR) plays an important role. TR consists of the application of telemedicine to rehabilitation to offer remote rehabilitation services to the population unable to reach healthcare. TR integrates therapy-recovery-assistance, with continuity of treatments, aimed at neurological and psychological recovery, involving the patient in a family environment, with an active role also of the caregivers. This leads to reduced healthcare costs and improves the continuity of specialist care, as well as showing efficacy for the treatment of cognitive disorders, and leading to advantages for patients and their families, such as avoiding travel, reducing associated costs, improving the frequency, continuity, and comfort of performing the rehabilitation in its own spaces, times and arrangements. The aim of this consensus paper is to investigate the current evidence on the use and effectiveness of TR in the cognitive field, trying to also suggest some recommendations and future perspectives. To the best of our knowledge, this is the first consensus paper among multiple expert researchers that comprehensively examines TR in different neurological diseases. Our results supported the efficacy and feasibility of TR with good adherence and no adverse events among patients. Our consensus summarizes the current evidence for the application of cognitive TR in neurological populations, highlighting the potential of this tool, but also the limitations that need to be explored further.
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Affiliation(s)
| | | | - Francesco Arcuri
- S. Anna Institute and Research in Advanced Neurorehabilitation, Crotone, Italy
| | | | - Marianna Contrada
- S. Anna Institute and Research in Advanced Neurorehabilitation, Crotone, Italy
| | | | - Carl Froilan Leochico
- University of the Philippines Manila, Manila, Philippines
- St. Luke’s Medical Center, Quezon City, Philippines
| | | | - Stefania Laratta
- S. Anna Institute and Research in Advanced Neurorehabilitation, Crotone, Italy
| | - Boris Suchan
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Paolo Tonin
- S. Anna Institute and Research in Advanced Neurorehabilitation, Crotone, Italy
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Abedi A, Colella TJF, Pakosh M, Khan SS. Artificial intelligence-driven virtual rehabilitation for people living in the community: A scoping review. NPJ Digit Med 2024; 7:25. [PMID: 38310158 PMCID: PMC10838287 DOI: 10.1038/s41746-024-00998-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 01/03/2024] [Indexed: 02/05/2024] Open
Abstract
Virtual Rehabilitation (VRehab) is a promising approach to improving the physical and mental functioning of patients living in the community. The use of VRehab technology results in the generation of multi-modal datasets collected through various devices. This presents opportunities for the development of Artificial Intelligence (AI) techniques in VRehab, namely the measurement, detection, and prediction of various patients' health outcomes. The objective of this scoping review was to explore the applications and effectiveness of incorporating AI into home-based VRehab programs. PubMed/MEDLINE, Embase, IEEE Xplore, Web of Science databases, and Google Scholar were searched from inception until June 2023 for studies that applied AI for the delivery of VRehab programs to the homes of adult patients. After screening 2172 unique titles and abstracts and 51 full-text studies, 13 studies were included in the review. A variety of AI algorithms were applied to analyze data collected from various sensors and make inferences about patients' health outcomes, most involving evaluating patients' exercise quality and providing feedback to patients. The AI algorithms used in the studies were mostly fuzzy rule-based methods, template matching, and deep neural networks. Despite the growing body of literature on the use of AI in VRehab, very few studies have examined its use in patients' homes. Current research suggests that integrating AI with home-based VRehab can lead to improved rehabilitation outcomes for patients. However, further research is required to fully assess the effectiveness of various forms of AI-driven home-based VRehab, taking into account its unique challenges and using standardized metrics.
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Affiliation(s)
- Ali Abedi
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
| | - Tracey J F Colella
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Shehroz S Khan
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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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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Cao W, Kadir AA, Tang W, Wang J, Yuan J, Hassan II. Effectiveness of mobile application interventions for stroke survivors: systematic review and meta-analysis. BMC Med Inform Decis Mak 2024; 24:6. [PMID: 38167316 PMCID: PMC10763083 DOI: 10.1186/s12911-023-02391-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Although smartphone usage is ubiquitous, and a vast amount of mobile applications have been developed for chronic diseases, mobile applications amongst stroke survivors remain unclear. OBJECTIVE This systematic review and meta-analysis aimed to determine the effectiveness of mobile applications on medication adherence, functional outcomes, cardiovascular risk factors, quality of life and knowledge on stroke in stroke survivors. METHODS A review of the literature was conducted using key search terms in PubMed, EMBASE, Cochrane and Web of Science databases until 16 March 2023 to identify eligible randomized controlled trials (RCTs) or controlled clinical trial (CCTs) of mobile application interventions among stroke survivors. Two reviewers independently screened the literature in accordance with the eligibility criteria and collected data from the articles included. Outcomes included medication adherence,functional outcomes,cardiovascular risk factors, quality of life,and knowledge of stroke. RESULTS Twenty-three studies involving 2983 participants across nine countries were included in this review. Sixteen trials involved health care professionals in app use, and seven trials reported measures to ensure app-based intervention adherence. Mobile applications targeting stroke survivors primarily encompassed three areas: rehabilitation, education and self-care. The participants in the studies primarily included young and middle-aged stroke survivors. Meta-analysis results demonstrated that mobile application intervention significantly improved trunk control ability (mean differences [MD] 3.00, 95% CI [1.80 to 4.20]; P < 0.00001), Fugl-Meyer assessment of upper extremity (MD 9.81, 95% CI [8.72 to 10.90]; P < 0.00001), low-density lipoprotein cholesterol (MD - 0.33, 95% CI [- 0.54 to - 0.11]; P = 0.003) and glycosylated haemoglobin A1c (HbA1c)<7 levels (MD 1.95, 95% CI [1.17 to 3.25]; P = 0.01). However, the mobile application intervention did not differ significantly in medication adherence, 10-min walk test (10 MWT), Barthel index, systolic blood pressure, diastolic blood pressure, high-density lipoprotein cholesterol, body mass index, smoking, health-related quality of life and knowledge of stroke. CONCLUSION Our study suggested that mobile application interventions may have a potential benefit to stroke survivors, but clinical effectiveness should be established. More studies using rigorous designs are warranted to understand their usefulness. Future research should also involve more older adult stroke survivors.
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Affiliation(s)
- Wenjing Cao
- Xiangnan University, Chenzhou, Hunan Province, China
- School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kubang, Kerian, 16150, Malaysia, Kelantan
| | - Azidah Abdul Kadir
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150, Malaysia, Kelantan
| | - Wenzhen Tang
- School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kubang, Kerian, 16150, Malaysia, Kelantan
| | - Juan Wang
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Jiamu Yuan
- Xiangnan University, Chenzhou, Hunan Province, China
| | - Intan Idiana Hassan
- School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kubang, Kerian, 16150, Malaysia, Kelantan.
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Hestetun-Mandrup AM, Toh ZA, Oh HX, He HG, Martinsen ACT, Pikkarainen M. Effectiveness of digital home rehabilitation and supervision for stroke survivors: A systematic review and meta-analysis. Digit Health 2024; 10:20552076241256861. [PMID: 38832099 PMCID: PMC11146002 DOI: 10.1177/20552076241256861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/26/2024] [Indexed: 06/05/2024] Open
Abstract
Objective Stroke survivors often experience residual impairments and motor decline post-discharge. While digital home rehabilitation combined with supervision could be a promising approach for reducing human resources, increasing motor ability, and supporting rehabilitation persistence there is a lack of reviews synthesizing the effects. Thus, this systematic review and meta-analysis aimed to synthesize the effect of digital home rehabilitation and supervision in improving motor ability of upper limb, static balance, stroke-related quality of life, and self-reported arm function among stroke survivors. Methods Six electronic databases, grey literature, ongoing studies, and reference lists were searched for relevant studies. Two investigators independently reviewed titles, abstracts, screened full texts for eligibility and performed data extraction. Meta-analysis of 13 independent studies were grouped into four separate meta-analyses. The Grading of Recommendations, Assessments, Development and Evaluations (GRADE) tool was used for evaluating the overall quality of the evidence. Results Meta-analyses showed no statistically significant difference between intervention (digital home rehabilitation) and control groups (home training/clinic-based) of all outcomes including motor ability of upper limb, static balance, stroke-related quality of life, and self-reported arm function. In the sub-group analysis digital home rehabilitation was associated with better quality of arm use (standardized mean difference = 0.68, 95% confidence interval: [0.27, 1.09], p = 0.001). Conclusions This result indicated that digital home rehabilitation has similar effects and could potentially replace home training or clinic-based services. This review highlights better-targeted digital motor interventions to examine the effects of interventions further. The quality of evidence was moderate to high in motor and self-reported arm outcomes, and low for balance and quality of life.
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Affiliation(s)
| | - Zheng An Toh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore
- Singapore General Hospital, Singapore
- National University Health System, Singapore
| | - Hui Xian Oh
- Singapore General Hospital, Singapore
- National University Health System, Singapore
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore
- National University Health System, Singapore
| | | | - Minna Pikkarainen
- Oslomet -Oslo Metropolitan University, Oslo, Norway
- University of Oulu, Oulu, Finland
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Federico S, Cacciante L, De Icco R, Gatti R, Jonsdottir J, Pagliari C, Franceschini M, Goffredo M, Cioeta M, Calabrò RS, Maistrello L, Turolla A, Kiper P. Telerehabilitation for Stroke: A Personalized Multi-Domain Approach in a Pilot Study. J Pers Med 2023; 13:1692. [PMID: 38138919 PMCID: PMC10744683 DOI: 10.3390/jpm13121692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
Stroke, a leading cause of long-term disability worldwide, manifests as motor, speech language, and cognitive impairments, necessitating customized rehabilitation strategies. In this context, telerehabilitation (TR) strategies have emerged as promising solutions. In a multi-center longitudinal pilot study, we explored the effects of a multi-domain TR program, comprising physiotherapy, speech therapy, and neuropsychological treatments. In total, 84 stroke survivors (74 analyzed) received 20 tailored sessions per domain, addressing individual impairments and customized to their specific needs. Positive correlations were found between initial motor function, cognitive status, independence in activities of daily living (ADLs), and motor function improvement after TR. A lower initial health-related quality of life (HRQoL) perception hindered progress, but improved ADL independence and overall health status, and reduced depression correlated with a better QoL. Furthermore, post-treatment improvements were observed in the entire sample in terms of fine motor skills, upper-limb functionality, balance, independence, and cognitive impairment. This multi-modal approach shows promise in enhancing stroke rehabilitation and highlights the potential of TR in addressing the complex needs of stroke survivors through a comprehensive support and interdisciplinary collaboration, personalized for each individual's needs.
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Affiliation(s)
- Sara Federico
- Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, 30126 Venice, Italy; (S.F.); (P.K.)
| | - Luisa Cacciante
- Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, 30126 Venice, Italy; (S.F.); (P.K.)
| | - Roberto De Icco
- Department of Brain and Behavioral Science, University of Pavia, 27100 Pavia, Italy;
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Roberto Gatti
- Humanitas Clinical and Research Center, IRCCS, Rozzano, 20148 Milan, Italy;
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20148 Milan, Italy
| | | | - Chiara Pagliari
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy; (J.J.); (C.P.)
| | - Marco Franceschini
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, 00163 Rome, Italy; (M.F.); (M.G.); (M.C.)
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, 00163 Rome, Italy
| | - Michela Goffredo
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, 00163 Rome, Italy; (M.F.); (M.G.); (M.C.)
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, 00163 Rome, Italy
| | - Matteo Cioeta
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, 00163 Rome, Italy; (M.F.); (M.G.); (M.C.)
| | | | | | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences—DIBINEM, Alma Mater Studiorum Università di Bologna, 40138 Bologna, Italy;
- Unit of Occupational Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Pawel Kiper
- Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, 30126 Venice, Italy; (S.F.); (P.K.)
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Quintana D, Rodríguez A, Boada I. Limitations and solutions of low cost virtual reality mirror therapy for post-stroke patients. Sci Rep 2023; 13:14780. [PMID: 37679388 PMCID: PMC10484971 DOI: 10.1038/s41598-023-40546-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/12/2023] [Indexed: 09/09/2023] Open
Abstract
Mirror therapy is applied to reduce phantom pain and as a rehabilitation technique in post-stroke patients. Using Virtual Reality and head-mounted displays this therapy can be performed in virtual scenarios. However, for its efficient use in clinical settings, some hardware limitations need to be solved. A new system to perform mirror therapy in virtual scenarios for post-stroke patients is proposed. The system requires the patient a standalone virtual reality headset with hand-tracking features and for the rehabilitator an external computer or tablet device. The system provides functionalities for the rehabilitator to prepare and follow-up rehabilitation sessions and a virtual scenario for the patient to perform rehabilitation. The system has been tested on a real scenario with the support of three experienced rehabilitators and considering ten post-stroke patients in individual sessions focused on upper limb motor rehabilitation. The development team observed all the sessions and took note of detected errors regarding technological aspects. Solutions to solve detected problems will be proposed and evaluated in terms of feasibility, performance cost, additional system cost, number of solved issues, new limitations, or advantages for the patient. Three types of errors were detected and solved. The first error is related to the position of the hands relative to the head-mounted display. To solve it the exercise area can be limited to avoid objectives that require turning the head too far. The second error is related to the interaction between the hands and the virtual objects. It can be solved making the main hand non-interactive. The last type of error is due to patient limitations and can be mitigated by having a virtual hand play out an example motion to bring the patient's attention back to the exercise. Other solutions have been evaluated positively and can be used in addition or instead of the selected ones. For mirror therapy based on virtual reality to be efficient in post-stroke rehabilitation the current head-mounted display-based solutions need to be complemented with specific strategies that avoid or mitigate the limitations of the technology and the patient. Solutions that help with the most common issues have been proposed.
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Affiliation(s)
- David Quintana
- Graphics and Imaging Laboratory, Institut Informàtica i Aplicacions, Universitat de Girona, Campus de Montilivi, 17003, Girona, Catalunya, Spain
| | - Antonio Rodríguez
- Graphics and Imaging Laboratory, Institut Informàtica i Aplicacions, Universitat de Girona, Campus de Montilivi, 17003, Girona, Catalunya, Spain
| | - Imma Boada
- Graphics and Imaging Laboratory, Institut Informàtica i Aplicacions, Universitat de Girona, Campus de Montilivi, 17003, Girona, Catalunya, Spain.
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Lazem H, Hall A, Gomaa Y, Mansoubi M, Lamb S, Dawes H. The Extent of Evidence Supporting the Effectiveness of Extended Reality Telerehabilitation on Different Qualitative and Quantitative Outcomes in Stroke Survivors: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6630. [PMID: 37681770 PMCID: PMC10487831 DOI: 10.3390/ijerph20176630] [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: 06/27/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
Objective: To present the extent of evidence concerning the effectiveness of extended reality telerehabilitation and patients' experiences of using different types of virtual reality exercises at home. Methods: We included studies on virtual reality and augmented reality telerehabilitation published in English. Systematic searches were undertaken in PubMed, Web of Sciences, Medline, Embase, CINAHL, and PEDro, with no date limitations. We included only RCTs and qualitative studies exploring patients' experiences. Methodological quality was assessed using the Cochrane Risk of Bias assessment tool for quantitative papers and the CASP scale for qualitative studies. All results are presented narratively. Results: Thirteen studies, nine quantitative and four qualitative, were included, with one qualitative and seven quantitative having a high risk of bias. All studies reported that extended reality-based telerehabilitation may be effective compared to conventional exercises or other extended reality exercises. Seven quantitative studies focused on upper limb function. Qualitative papers suggested that VR exercises were perceived as feasible by patients. Conclusions: The literature suggests VR home exercises are feasible and potentially effective for patients after a stroke in the upper limb. Further high-quality studies are needed to examine the effectiveness of XR exercises early adoption on different qualitative and quantitative outcomes. Registration number: (CRD42022384356).
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Affiliation(s)
- Hatem Lazem
- Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter EX1 2LP, UK; (A.H.); (M.M.); (S.L.); (H.D.)
- Basic Science Department, Faculty of Physical Therapy, Cairo University, Cairo 12613, Egypt
| | - Abi Hall
- Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter EX1 2LP, UK; (A.H.); (M.M.); (S.L.); (H.D.)
| | - Yasmine Gomaa
- Faculty of Physical Therapy, Kafr Elsheikh University, Kafr Elsheikh 6860404, Egypt;
| | - Maedeh Mansoubi
- Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter EX1 2LP, UK; (A.H.); (M.M.); (S.L.); (H.D.)
| | - Sallie Lamb
- Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter EX1 2LP, UK; (A.H.); (M.M.); (S.L.); (H.D.)
| | - Helen Dawes
- Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter EX1 2LP, UK; (A.H.); (M.M.); (S.L.); (H.D.)
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Xing Y, Xiao J, Zeng B, Wang Q. ICTs and interventions in telerehabilitation and their effects on stroke recovery. Front Neurol 2023; 14:1234003. [PMID: 37645607 PMCID: PMC10460969 DOI: 10.3389/fneur.2023.1234003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/04/2023] [Indexed: 08/31/2023] Open
Abstract
Telerehabilitation (TR) is a new model to provide rehabilitation services to stroke survivors. It is a promising approach to deliver mainstream interventions for movement, cognitive, speech and language, and other disorders. TR has two major components: information and communication technologies (ICTs) and stroke interventions. ICTs provide a platform on which interventions are delivered and subsequently result in stroke recovery. In this mini-review, we went over features of ICTs that facilitate TR, as well as stroke interventions that can be delivered via TR platforms. Then, we reviewed the effects of TR on various stroke disorders. In most studies, TR is a feasible and effective solution in delivering interventions to patients. It is not inferior to usual care and in-clinic therapy with matching dose and intensity. With new technologies, TR may result in better outcomes than usual care for some disorders. One the other hand, TR also have many limitations that could lead to worse outcomes than traditional rehabilitation. In the end, we discussed major concerns and possible solutions related to TR, and also discussed potential directions for TR development.
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Affiliation(s)
- Yanghui Xing
- Department of Biomedical Engineering, Shantou University, Shantou, China
| | - Jianxin Xiao
- Department of Biomedical Engineering, Shantou University, Shantou, China
| | - Buhui Zeng
- Department of Biomedical Engineering, Shantou University, Shantou, China
| | - Qiang Wang
- National Research Center for Rehabilitation Technical Aids, Ministry of Civil Affairs, Beijing, China
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Placidi G, Di Matteo A, Lozzi D, Polsinelli M, Theodoridou E. Patient-Therapist Cooperative Hand Telerehabilitation through a Novel Framework Involving the Virtual Glove System. SENSORS (BASEL, SWITZERLAND) 2023; 23:3463. [PMID: 37050523 PMCID: PMC10098681 DOI: 10.3390/s23073463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 06/19/2023]
Abstract
Telerehabilitation is important for post-stroke or post-surgery rehabilitation because the tasks it uses are reproducible. When combined with assistive technologies, such as robots, virtual reality, tracking systems, or a combination of them, it can also allow the recording of a patient's progression and rehabilitation monitoring, along with an objective evaluation. In this paper, we present the structure, from actors and functionalities to software and hardware views, of a novel framework that allows cooperation between patients and therapists. The system uses a computer-vision-based system named virtual glove for real-time hand tracking (40 fps), which is translated into a light and precise system. The novelty of this work lies in the fact that it gives the therapist quantitative, not only qualitative, information about the hand's mobility, for every hand joint separately, while at the same time providing control of the result of the rehabilitation by also quantitatively monitoring the progress of the hand mobility. Finally, it also offers a strategy for patient-therapist interaction and therapist-therapist data sharing.
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Affiliation(s)
- Giuseppe Placidi
- AVI-Lab, Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Alessandro Di Matteo
- AVI-Lab, Department of Information Engineering, Computer Science and Mathematics, University of L’Aquila, 67100 L’Aquila, Italy
| | - Daniele Lozzi
- AVI-Lab, Department of Information Engineering, Computer Science and Mathematics, University of L’Aquila, 67100 L’Aquila, Italy
| | - Matteo Polsinelli
- Department of Computer Science, University of Salerno, 84084 Fisciano, Italy
| | - Eleni Theodoridou
- AVI-Lab, Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
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