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Olowoyo P, Dhamija RK, Owolabi MO. Telerehabilitation - historical perspectives and conceptual framework in reference to neurological disorders: A narrative review. NeuroRehabilitation 2024:NRE240079. [PMID: 38995808 DOI: 10.3233/nre-240079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
BACKGROUND Telerehabilitation as a new subdiscipline of telehealth is the application of information technology to support and deliver rehabilitation services via two-way or multipoint interactive online telecommunication technology. This enables the therapist to optimize the timing, intensity, and duration of therapy which is often not possible within the constraints of face-to-face treatment protocols in current health systems. OBJECTIVE To review the historical perspective and conceptual framework of telerehabilitation in neurological disorders. METHODS A narrative review of the literature was performed for the historical perspective and a systematic review of the conceptual framework was performed using the PRISMA guidelines on chronic neurological disorders; multiple sclerosis, spinal cord injury, stroke, Parkinson's disease, cognitive impairment, and headaches. The search included articles from the past 20 years (2004 to 2024). RESULTS Telerehabilitation dates back to the 1960s and early 1970s. Documented effective interventions were mostly on therapies for speech disorders. The conceptual framework consisted of three major components of telerehabilitation programmes including development, implementation, and evaluation. The COVID-19 pandemic suddenly made telerehabilitation come to the limelight because physical distancing became necessary. Out of the 110,000 articles downloaded, 43 met the inclusion criteria for review on the conceptual framework of telerehabilitation in relation to neurological disorders. The articles discussed multiple sclerosis (2), spinal cord disorders (1), stroke (17), Parkinson's disease (15), headaches (3), and cognitive disorders (5). All articles reviewed assessed the effectiveness of telemedicine except for the articles on multiple sclerosis and spinal cord disorders which examined the interphase between the technology and the end users. CONCLUSION The future of telerehabilitation looks promising with the subsequent integration of innovative tools and applications. This will require the adaption of technology, continuous capacity building, education, and training of healthcare professionals to ensure that they are adequately equipped with the necessary skills to provide quality virtual reality rehabilitation care.
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Affiliation(s)
- Paul Olowoyo
- Department of Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Rajinder K Dhamija
- Department of Neurology, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - Mayowa O Owolabi
- Neurology Department, University College Hospital, Ibadan, Nigeria
- Center for Genomics and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Lebanese American University, Beirut, Lebanon
- Department of Medicine, University College Hospital, Ibadan, Nigeria
- Blossom Specialist Medical Center, Ibadan, Nigeria
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2
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Raggi A, Serretti A, Ferri R. A comprehensive overview of post-stroke depression treatment options. Int Clin Psychopharmacol 2024; 39:127-138. [PMID: 38170802 DOI: 10.1097/yic.0000000000000532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Nearly one-third of all stroke patients develop depression at any time after a stroke, and its presence is associated with unfavorable outcomes. This narrative review aims to provide a synopsis of possible pharmacological and non-pharmacological treatment modalities for post-stroke depression (PSD). Several studies have demonstrated the efficacy and safety of selective serotonin reuptake inhibitors in treating the symptoms of this clinical condition. The treatment of PSD has been recently enhanced by innovative approaches, such as cognitive-behavioral therapy, virtual reality, telehealth, repetitive transcranial magnetic stimulation, and non-conventional therapies, which might improve depression treatment in stroke survivors. Future high-quality randomized controlled trials are necessary to confirm this hypothesis.
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Affiliation(s)
- Alberto Raggi
- Unit of Neurology, G.B. Morgagni - L. Pierantoni Civic Hospital, Forlì
| | | | - Raffaele Ferri
- Department of Neurology, Oasi Research Institute - IRCCS, Troina, Italy
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Rose Sin Yi L, Jing Jing S, Hammoda AO, Jonathan B, Ladislav B, Jing Q. Effects of virtual reality-based cognitive interventions on cognitive function and activity of daily living among stroke patients: Systematic review and meta-analysis. J Clin Nurs 2024; 33:1169-1184. [PMID: 38234275 DOI: 10.1111/jocn.16986] [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: 10/14/2022] [Revised: 10/24/2023] [Accepted: 12/12/2023] [Indexed: 01/19/2024]
Abstract
AIMS To examine the effects of virtual reality-based cognitive interventions on cognitive function and activities of daily living among stroke patients, and to identify the optimal design for such intervention. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, EMBASE, Cochrane, CINANL, JBI-EBP and Web of Science from inception to October 2023. METHODS Methodological quality was assessed by Risk of Bias Tool. Meta-analyses were assessed by Review Manager 5.4. Subgroup analyses were conducted to explore the influence of study design. Grading of Recommendations Assessment, Development and Evaluation approach was adopted to assess the certainty of evidence. RESULTS Twenty-five randomized controlled trials (1178 participants) were included. Virtual reality-based cognitive interventions demonstrated moderate-to-large effects in improving global cognitive function (SMD = 0.43; 95% CI [0.01, 0.85]), executive function (SMD = 0.84; 95% CI [0.25, 1.43]) and memory (SMD = 0.65; 95% CI [0.15, 1.16]) compared to control treatments. No significant effects were found on language, visuospatial ability and activities of daily living. Subgroup analyses indicated one-on-one coaching, individualized design and dynamic difficulty adjustment, and interventions lasting ≥ 6 weeks had particularly enhanced effects, especially for executive function. CONCLUSIONS Virtual reality-based cognitive interventions improve global cognitive function, executive function and memory among stroke patients. IMPLICATIONS FOR THE PATIENT CARE This review underscores the broad cognitive advantages offered by virtual technology, suggesting its potential integration into standard stroke rehabilitation protocols for enhanced cognitive recovery. IMPACT The study identifies key factors in virtual technology interventions that effectively improve cognitive function among stroke patients, offering healthcare providers a framework for leveraging such technology to optimize cognitive outcomes in stroke rehabilitation. REPORTING METHOD PRISMA 2020 statement. PROSPERO REGISTRATION NUMBER CRD42022342668.
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Affiliation(s)
- Lin Rose Sin Yi
- School of Nursing, Elaine C. Hubbard Center for Nursing Research on Aging, University of Rochester, Rochester, New York, USA
| | - Su Jing Jing
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Abu-Odah Hammoda
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Bayuo Jonathan
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Batalik Ladislav
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Qin Jing
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Naamanka E, Salakka I, Parkkila M, Hotti J, Poutiainen E. Effectiveness of teleneuropsychological rehabilitation: Systematic review of randomized controlled trials. J Int Neuropsychol Soc 2024; 30:295-312. [PMID: 37746802 DOI: 10.1017/s1355617723000565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
OBJECTIVE The effectiveness of neuropsychological rehabilitation is supported by the evidence found in previous reviews, but there is a lack of research regarding the effectiveness of remotely conducted neuropsychological rehabilitation. This review aimed to identify and evaluate the results of studies investigating the effectiveness of teleneuropsychological rehabilitation. METHODS Relevant articles were extracted from electronic databases and filtered to include studies published in 2016 or later to focus on recent practices. Data were synthesized narratively. RESULTS A total of 14 randomized controlled studies were included in the synthesis (9 for children/adolescents, 5 for adults). The most common type of intervention was computerized cognitive training with regular remote contact with the therapist (seven studies). Regarding children and adolescents, the evidence for the effectiveness was found only for these types of interventions with improvements in cognitive outcomes. The results regarding the family-centered interventions were mixed with improvements only found in psychosocial outcomes. No support was found for the effectiveness of interventions combining cognitive and motor training. Regarding adults, all included studies offered support for the effectiveness, at least to some extent. There were improvements particularly in trained cognitive functions. Long-term effects of the interventions with generalization to global functioning remained somewhat unclear. CONCLUSION Remote interventions focused on computerized cognitive training are promising methods within teleneuropsychological rehabilitation. However, their impact on long-term meaningful, everyday functioning remained unclear. More research is needed to reliably assess the effectiveness of teleneuropsychological interventions, especially with more comprehensive approaches.
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Affiliation(s)
| | - Ilja Salakka
- Rehabilitation Foundation, Helsinki, Finland
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Joona Hotti
- Rehabilitation Foundation, Helsinki, Finland
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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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Tsiakiri A, Christidi F, Tsiptsios D, Vlotinou P, Kitmeridou S, Bebeletsi P, Kokkotis C, Serdari A, Tsamakis K, Aggelousis N, Vadikolias K. Processing Speed and Attentional Shift/Mental Flexibility in Patients with Stroke: A Comprehensive Review on the Trail Making Test in Stroke Studies. Neurol Int 2024; 16:210-225. [PMID: 38392955 PMCID: PMC10893544 DOI: 10.3390/neurolint16010014] [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: 12/30/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024] Open
Abstract
The Trail Making Test (TMT) is one of the most commonly administered tests in clinical and research neuropsychological settings. The two parts of the test (part A (TMT-A) and part B (TMT-B)) enable the evaluation of visuoperceptual tracking and processing speed (TMT-A), as well as divided attention, set-shifting and cognitive flexibility (TMT-B). The main cognitive processes that are assessed using TMT, i.e., processing speed, divided attention, and cognitive flexibility, are often affected in patients with stroke. Considering the wide use of TMT in research and clinical settings since its introduction in neuropsychological practice, the purpose of our review was to provide a comprehensive overview of the use of TMT in stroke patients. We present the most representative studies assessing processing speed and attentional shift/mental flexibility in stroke settings using TMT and applying scoring methods relying on conventional TMT scores (e.g., time-to-complete part A and part B), as well as derived measures (e.g., TMT-(B-A) difference score, TMT-(B/A) ratio score, errors in part A and part B). We summarize the cognitive processes commonly associated with TMT performance in stroke patients (e.g., executive functions), lesion characteristics and neuroanatomical underpinning of TMT performance post-stroke, the association between TMT performance and patients' instrumental activities of daily living, motor difficulties, speech difficulties, and mood statue, as well as their driving ability. We also highlight how TMT can serve as an objective marker of post-stroke cognitive recovery following the implementation of interventions. Our comprehensive review underscores that the TMT stands as an invaluable asset in the stroke assessment toolkit, contributing nuanced insights into diverse cognitive, functional, and emotional dimensions. As research progresses, continued exploration of the TMT potential across these domains is encouraged, fostering a deeper comprehension of post-stroke dynamics and enhancing patient-centered care across hospitals, rehabilitation centers, research institutions, and community health settings. Its integration into both research and clinical practice reaffirms TMT status as an indispensable instrument in stroke-related evaluations, enabling holistic insights that extend beyond traditional neurological assessments.
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Affiliation(s)
- Anna Tsiakiri
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Foteini Christidi
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Dimitrios Tsiptsios
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Pinelopi Vlotinou
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Sofia Kitmeridou
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Paschalina Bebeletsi
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 691 00 Komotini, Greece; (C.K.); (N.A.)
| | - Aspasia Serdari
- Department of Child and Adolescent Psychiatry, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece;
| | - Konstantinos Tsamakis
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AB, UK;
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 691 00 Komotini, Greece; (C.K.); (N.A.)
| | - Konstantinos Vadikolias
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
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Formica C, Bonanno M, Sorbera C, Quartarone A, Giambò FM, Marra A, Calabrò RS. Smartphone-Based Cognitive Telerehabilitation: A Usability and Feasibility Study Focusing on Mild Cognitive Impairment. SENSORS (BASEL, SWITZERLAND) 2024; 24:525. [PMID: 38257618 PMCID: PMC10820398 DOI: 10.3390/s24020525] [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: 12/15/2023] [Revised: 01/03/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024]
Abstract
The implementation of cognitive health apps in patients with mild cognitive impairment (MCI) is challenging because of their cognitive, age, and other clinical characteristics. In this project, we aimed to evaluate the usability and feasibility of the Rehastart app tested in MCI patients. Eighteen subjects affected by MCI due to neurodegenerative disorders (including Parkinson's disease, multiple sclerosis, and amnestic/multidomain MCI) and eighteen healthcare professionals were recruited to this study. Patients were registered on the app by clinicians and they were assigned a protocol of specific cognitive exercises. The recruitment was conducted in the period between March and June 2023. The trial testing of the app consisted of three sessions per week for three weeks, with each session lasting about 30 min. After three weeks, the participants as well as medical personnel were invited to rate the usability and feasibility of the Rehastart mobile application. The instruments employed to evaluate the usability and feasibility of the app were the System Usability Scale (SUS), The Intrinsic Motivation Inventory (IMI) and the Client Satisfaction Questionnaire (CSQ). We did not find statistically significant differences on the SUS (p = 0.07) between healthcare professionals and patients. In addition, we found promising results on subscales of the Intrinsic Motivation Inventory, suggesting high levels of interest and enjoyment when using the Rehastart app. Our study demonstrated that smartphone-based telerehabilitation could be a suitable tool for people with MCI due to neurodegenerative disorders, since the Rehastart app was easy to use and motivating for both patients and healthy people.
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Affiliation(s)
| | - Mirjam Bonanno
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, S.S. 113, 98124 Messina, Italy; (C.F.); (C.S.); (A.Q.); (F.M.G.); (A.M.); (R.S.C.)
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Cruz-Panesso I, Tanoubi I, Drolet P. Telehealth Competencies: Training Physicians for a New Reality? Healthcare (Basel) 2023; 12:93. [PMID: 38200999 PMCID: PMC10779292 DOI: 10.3390/healthcare12010093] [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: 10/08/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
In North America, telehealth increased by 40% between 2019 and 2020 and stabilized at 40% in 2021. As telehealth becomes more common, it is essential to ensure that healthcare providers have the required skills to overcome the challenges and barriers of this new modality of care. While the COVID-19 pandemic has accelerated the design and implementation of telehealth curricula in healthcare education programs, its general adoption is still a major gap and an important barrier to ensuring scaling up and sustainability of the telesshealth practice. Lack of experienced faculty and limited curricular time are two of the most common barriers to expanding telehealth education. Overcoming the barriers of telehealth curricula implementation may require moving away from the classic expert model of learning in which novices learn from experts. As the adoption of telehealth curricula is still in its early stages, institutions may need to plan for faculty development and trainee education at the same time. Questions regarding the timing and content of telehealth education, the interprofessional development of curricula, and the identification of optimal pedagogical methods remain open and crucial. This article reflects on these questions and presents telesimulation as an ideal instructional method for the training of telehealth competencies. Telesimulation can provide opportunities for practical training across a range of telehealth competencies, fostering not only technical proficiency but also communication skills and interprofessional collaboration.
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Affiliation(s)
- Ilian Cruz-Panesso
- Medical Simulation Centre, Centre d’Apprentissage des Attitudes et Habiletés Cliniques (CAAHC), University of Montreal, Montreal, QC H3T 1J4, Canada; (I.T.); (P.D.)
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Goffredo M, Baglio F, DE Icco R, Proietti S, Maggioni G, Turolla A, Pournajaf S, Jonsdottir J, Zeni F, Federico S, Cacciante L, Cioeta M, Tassorelli C, Franceschini M, Calabrò RS. Efficacy of non-immersive virtual reality-based telerehabilitation on postural stability in Parkinson's disease: a multicenter randomized controlled trial. Eur J Phys Rehabil Med 2023; 59:689-696. [PMID: 37847247 PMCID: PMC10795069 DOI: 10.23736/s1973-9087.23.07954-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/19/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND The implementation of regular prolonged, and effective rehabilitation in people with Parkinson's disease is essential for ensuring a good quality of life. However, the continuity of rehabilitation care may find barriers related to economic, geographic, and social issues. In these scenarios, telerehabilitation could be a possible solution to guarantee the continuity of care. AIM To investigate the efficacy of non-immersive virtual reality-based telerehabilitation on postural stability in people with Parkinson's disease, compared to at-home self-administered structured conventional motor activities. DESIGN Multicenter randomized controlled trial. SETTING Five rehabilitation hospitals of the Italian Neuroscience and Rehabilitation Network. POPULATION Individuals diagnosed with Parkinson's disease. METHODS Ninety-seven participants were randomized into two groups: 49 in the telerehabilitation group (non-immersive virtual reality-based telerehabilitation) and 48 in the control group (at-home self-administered structured conventional motor activities). Both treatments lasted 30 sessions (3-5 days/week for, 6-10 weeks). Static and dynamic balance, gait, and functional motor outcomes were registered before and after the treatments. RESULTS All participants improved the outcomes at the end of the treatments. The primary outcome (mini-Balance Evaluation Systems Test) registered a greater significant improvement in the telerehabilitation group than in the control group. The gait and endurance significantly improved in the telerehabilitation group only, with significant within-group and between-group differences. CONCLUSIONS Our results showed that non-immersive virtual reality-based telerehabilitation is feasible, improves static and dynamic balance, and is a reasonably valuable alternative for reducing postural instability in people with Parkinson's disease. CLINICAL REHABILITATION IMPACT Non-immersive virtual reality-based telerehabilitation is an effective and well-tolerated modality of rehabilitation which may help to improve access and scale up rehabilitation services as suggested by the World Health Organization's Rehabilitation 2030 agenda.
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Affiliation(s)
- Michela Goffredo
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | | | - Roberto DE Icco
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Stefania Proietti
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, Rome, Italy
| | - Giorgio Maggioni
- Unità di Neuroriabilitazione, ICS Maugeri SB IRCCS Veruno, Veruno, Novara, Italy
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater University of Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Sanaz Pournajaf
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | | | - Federica Zeni
- Unità di Neuroriabilitazione, ICS Maugeri SB IRCCS Veruno, Veruno, Novara, Italy
| | - Sara Federico
- Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, Venice, Italy
| | - Luisa Cacciante
- Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, Venice, Italy
| | - Matteo Cioeta
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Marco Franceschini
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, Rome, Italy
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Stammler B, Flammer K, Schuster T, Lambert M, Neumann O, Lux M, Matuz T, Karnath HO. Spatial Neglect Therapy With the Augmented Reality App "Negami" for Active Exploration Training: A Randomized Controlled Trial on 20 Stroke Patients With Spatial Neglect. Arch Phys Med Rehabil 2023; 104:1987-1994. [PMID: 37582475 DOI: 10.1016/j.apmr.2023.07.017] [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: 03/24/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE To investigate the efficacy of the augmented reality (AR) app "Negami" as an active exploration training for the treatment of spatial neglect. Improvements of the ipsilesional attention and orientation bias (and resulting contralesional neglect) will be examined in stroke patients with spatial neglect and compared with a control group. DESIGN Randomized controlled trial with an experimental Negami group, consisting of patients with spatial neglect, and a group of neglect patients receiving standard neglect therapy. SETTING Three rehabilitation hospitals. PARTICIPANTS Twenty right hemispheric stroke patients with spatial neglect (N=20). INTERVENTION Over a period of 2 weeks, both groups received 5 training sessions per week (à 25 minutes). Neglect behavior was assessed weekly over a 5-week period, with the Negami therapy group receiving a second follow-up assessment at 1-to-2-month intervals after completion of training. MAIN OUTCOME MEASURES Letter Cancellation, Bells Test, Copying Task, Line Bisection Task, and a self-developed "Exploration Test". RESULTS Both groups improved significantly. While the Negami therapy group improved in 4 of 5 neglect tests used, the standard therapy group improved in only 1 of these tests. We observed significantly better improvement in the Negami group already after the first week of training. This difference was also significant after the end of the training as well as 1 week after the end of training and remained stable 1-2 months after the end of treatment. CONCLUSION Negami can be used as an effective alternative or addition to current standard neglect therapy, and may even be superior to it.
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Affiliation(s)
- Britta Stammler
- Center of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | | | | | | | | | - Michael Lux
- Neurological Rehabilitation Center Quellenhof, Sana Kliniken AG, Bad Wildbad, Germany
| | - Tamara Matuz
- Center of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; Kreiskliniken Reutlingen, Reutlingen, Germany
| | - Hans-Otto Karnath
- Center of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
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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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Wang C, Kong J, Qi H. Areas of Research Focus and Trends in the Research on the Application of VR in Rehabilitation Medicine. Healthcare (Basel) 2023; 11:2056. [PMID: 37510497 PMCID: PMC10379147 DOI: 10.3390/healthcare11142056] [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: 06/14/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVE To establish the areas of research focus in the application of VR in rehabilitation medicine, analyze its themes and trends, and offer a reference for future related research in this field. METHODS This paper provides an in-depth analysis of the development process, areas of research focus, and research trends in the field of the application of VR in rehabilitation medicine, using the Web of Science core dataset as the source and using a bibliometric analysis with CiteSpace. RESULTS The application of VR in rehabilitation medicine was composed of three stages, and the research topics were reviewed from five perspectives: neurological rehabilitation, psychological treatment, pain distraction, cardiopulmonary rehabilitation, and visual-spatial disorder. LIMITATIONS The research data were sourced from the Web of Science core dataset only, and the data-sample size was not comprehensive. CONCLUSIONS Overcoming VR-technology-induced vertigo, mental disorders from the overuse of VR, individualized treatments, and integration with traditional therapy are all challenges in the application of VR in rehabilitation medicine that require research. In addition, developing VR products with better experiences, constructing standardized guidelines, and conducting more high-quality clinical studies are all future research topics related to the application of VR in rehabilitation medicine.
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Affiliation(s)
- Chen Wang
- Department of Health Informatics and Management, The School of Health Humanities, Peking University, Beijing 100191, China
| | - Jingqi Kong
- Department of Language and Culture in Medicine, The School of Health Humanities, Peking University, Beijing 100191, China
| | - Huiying Qi
- Department of Health Informatics and Management, The School of Health Humanities, Peking University, Beijing 100191, China
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Worlikar H, Coleman S, Kelly J, O'Connor S, Murray A, McVeigh T, Doran J, McCabe I, O'Keeffe D. Mixed Reality Platforms in Telehealth Delivery: Scoping Review. JMIR BIOMEDICAL ENGINEERING 2023; 8:e42709. [PMID: 38875694 PMCID: PMC11041465 DOI: 10.2196/42709] [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: 09/14/2022] [Revised: 11/03/2022] [Accepted: 11/16/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The distinctive features of the digital reality platforms, namely augmented reality (AR), virtual reality (VR), and mixed reality (MR) have extended to medical education, training, simulation, and patient care. Furthermore, this digital reality technology seamlessly merges with information and communication technology creating an enriched telehealth ecosystem. This review provides a composite overview of the prospects of telehealth delivered using the MR platform in clinical settings. OBJECTIVE This review identifies various clinical applications of high-fidelity digital display technology, namely AR, VR, and MR, delivered using telehealth capabilities. Next, the review focuses on the technical characteristics, hardware, and software technologies used in the composition of AR, VR, and MR in telehealth. METHODS We conducted a scoping review using the methodological framework and reporting design using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Full-length articles in English were obtained from the Embase, PubMed, and Web of Science databases. The search protocol was based on the following keywords and Medical Subject Headings to obtain relevant results: "augmented reality," "virtual reality," "mixed-reality," "telemedicine," "telehealth," and "digital health." A predefined inclusion-exclusion criterion was developed in filtering the obtained results and the final selection of the articles, followed by data extraction and construction of the review. RESULTS We identified 4407 articles, of which 320 were eligible for full-text screening. A total of 134 full-text articles were included in the review. Telerehabilitation, telementoring, teleconsultation, telemonitoring, telepsychiatry, telesurgery, and telediagnosis were the segments of the telehealth division that explored the use of AR, VR, and MR platforms. Telerehabilitation using VR was the most commonly recurring segment in the included studies. AR and MR has been mainly used for telementoring and teleconsultation. The most important technical features of digital reality technology to emerge with telehealth were virtual environment, exergaming, 3D avatars, telepresence, anchoring annotations, and first-person viewpoint. Different arrangements of technology-3D modeling and viewing tools, communication and streaming platforms, file transfer and sharing platforms, sensors, high-fidelity displays, and controllers-formed the basis of most systems. CONCLUSIONS This review constitutes a recent overview of the evolving digital AR and VR in various clinical applications using the telehealth setup. This combination of telehealth with AR, VR, and MR allows for remote facilitation of clinical expertise and further development of home-based treatment. This review explores the rapidly growing suite of technologies available to users within the digital health sector and examines the opportunities and challenges they present.
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Affiliation(s)
- Hemendra Worlikar
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, University of Galway, Galway, Ireland
| | - Sean Coleman
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, University of Galway, Galway, Ireland
- Department of Medicine, University Hospital Galway, Galway, Ireland
| | - Jack Kelly
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, University of Galway, Galway, Ireland
- Department of Medicine, University Hospital Galway, Galway, Ireland
| | - Sadhbh O'Connor
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, University of Galway, Galway, Ireland
- Department of Medicine, University Hospital Galway, Galway, Ireland
| | - Aoife Murray
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, University of Galway, Galway, Ireland
| | - Terri McVeigh
- Cancer Genetics Unit, The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
| | - Jennifer Doran
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, University of Galway, Galway, Ireland
| | - Ian McCabe
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, University of Galway, Galway, Ireland
| | - Derek O'Keeffe
- Department of Medicine, University Hospital Galway, Galway, Ireland
- School of Medicine, College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland
- Lero, Science Foundation Ireland Centre for Software Research, University of Limerick, Limerick, Ireland
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14
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Liu H, Cheng Z, Wang S, Jia Y. Effects of virtual reality-based intervention on depression in stroke patients: a meta-analysis. Sci Rep 2023; 13:4381. [PMID: 36928345 PMCID: PMC10020160 DOI: 10.1038/s41598-023-31477-z] [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: 10/16/2021] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
As one of the most common neuropsychiatric complications after stroke, post-stroke depression can significantly affect the initiative of rehabilitation exercise and the rehabilitation of neurological function of patients. Virtual reality (VR) has been widely used in health-related fields in recent years. There is some evidence that VR-based interventions have benefits for depression. The aim of this study was to assess the effectiveness of VR-based intervention on depression in stroke patients. A total of 752 patients with stroke from 11 randomized controlled trials (RCTs) studies were included in this meta-analysis and the studies derived from seven electronic databases searched from database inception to August 2021. Different tools were used to measure depression. For continuous results, the standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated to synthesize the effects. We assessed the risk of bias by using the Cochrane Collaboration criteria. The results showed that compared to the control group, VR-based interventions significantly decreased the depression scale score (SMD = - 0.75, 95% CI - 1.35, - 0.15). The meta-analysis indicated that VR-based intervention had a moderate effect on depression in stroke patients compared to control group. There was no evidence of potential publication bias as assessed by visual inspection of funnel plots in Egger and Begg tests. Substantial heterogeneity between studies was observed, meta-regression analysis showed that mean age might be the source of heterogeneity.
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Affiliation(s)
- Hebing Liu
- The Second Hospital, Jilin University, No. 218 Ziqiang Street, Changchun, 130021, Jilin, China
| | - Zhaohua Cheng
- The Second Hospital, Jilin University, No. 218 Ziqiang Street, Changchun, 130021, Jilin, China
| | - Shuo Wang
- School of Nursing, Xuzhou Medical University, Tongshan Road, Xuzhou, 221004, Jiangsu, China
| | - Yong Jia
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun, 130021, Jilin, China.
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Macchitella L, Amendola S, Barraco G, Scoditti S, Gallo I, Oliva MC, Trabacca A. A narrative review of the use of a cutting-edge virtual reality rehabilitation technology in neurological and neuropsychological rehabilitation. NeuroRehabilitation 2023; 53:439-457. [PMID: 38143388 PMCID: PMC10789333 DOI: 10.3233/nre-230066] [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: 04/10/2023] [Accepted: 12/05/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Virtual reality (VR) interventions have been increasingly used in the rehabilitation of a wide range of neurological and neuropsychological dysfunctions. Findings of previous reviews showed positive and promising effects of VR-based interventions. However, they summarized findings on VR-based intervention carried out through different VR systems and tasks. OBJECTIVE We carried out a narrative review with the aim of qualitatively synthesising the results of previous studies that used specific VR systems, i.e. the Khymeia -Virtual Reality Rehabilitation System, for treatment purposes. METHODS We searched the literature in various databases (i.e. EMBASE, Web of Science, SCOPUS, PubMed and PubMed Central) for studies published until November 23, 2023. RESULTS 30 studies were selected. The VRRS was used for neuromotor rehabilitation only in 13 studies, for cognitive rehabilitation in 11 studies, and for both neuromotor and cognitive rehabilitation in six studies. The study design was heterogeneous including 15 randomised controlled trials. CONCLUSION After discussing each study according to the type of rehabilitation we concluded that the use and efficacy of VRRS rehabilitative intervention for increasing the neurological and neuropsychological functioning of patients are promising but more evidence is needed to make a comparison with conventional treatment. Future studies should also include long-term follow-up as well as cost-effectiveness analysis.
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Affiliation(s)
- Luigi Macchitella
- Scientific Institute IRCCS “E. Medea”, Unit for Severe Disabilities in Developmental Age and Young Adults (Developmental Neurology and Neurorehabilitation), Brindisi, Italy
| | - Simone Amendola
- Scientific Institute IRCCS “E. Medea”, Unit for Severe Disabilities in Developmental Age and Young Adults (Developmental Neurology and Neurorehabilitation), Brindisi, Italy
| | - Giulia Barraco
- Scientific Institute IRCCS “E. Medea”, Unit for Severe Disabilities in Developmental Age and Young Adults (Developmental Neurology and Neurorehabilitation), Brindisi, Italy
| | - Sara Scoditti
- Scientific Institute IRCCS “E. Medea”, Unit for Severe Disabilities in Developmental Age and Young Adults (Developmental Neurology and Neurorehabilitation), Brindisi, Italy
| | - Ivana Gallo
- Scientific Institute IRCCS “E. Medea”, Unit for Severe Disabilities in Developmental Age and Young Adults (Developmental Neurology and Neurorehabilitation), Brindisi, Italy
| | - Maria Carmela Oliva
- Scientific Institute IRCCS “E. Medea”, Unit for Severe Disabilities in Developmental Age and Young Adults (Developmental Neurology and Neurorehabilitation), Brindisi, Italy
| | - Antonio Trabacca
- Scientific Institute IRCCS “E. Medea”, Unit for Severe Disabilities in Developmental Age and Young Adults (Developmental Neurology and Neurorehabilitation), Brindisi, Italy
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16
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Gutierrez-Arias R, González-Mondaca C, Marinkovic-Riffo V, Ortiz-Puebla M, Paillán-Reyes F, Seron P. Considerations for ensuring safety during telerehabilitation of people with stroke. A protocol for a scoping review. PLoS One 2023; 18:e0276354. [PMID: 36608020 PMCID: PMC9821787 DOI: 10.1371/journal.pone.0276354] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Exercise interventions have a positive impact on people with stroke. However, access to exercise interventions is variable, and there may be a delay in the start of rehabilitation. Telerehabilitation has enabled the delivery of exercise interventions replacing the traditional face-to-face approach. Aspects related to the safety of people with stroke should be considered to avoid adverse events during the delivery of exercise interventions remotely. However, such information is scattered in the literature, and the detail with which measures taken during the implementation of exercise interventions for people with stroke are reported is unknown. OBJECTIVE To summarise measures or aspects targeted at reducing the incidence of adverse events during the delivery of exercise interventions through telerehabilitation in patients after stroke. MATERIALS AND METHODS A scoping review will be conducted. A systematic search in MEDLINE-Ovid, Embase-Ovid CENTRAL, CINAHL Complete (EBSCOhost), and other resources will be carried out. We will include primary studies, published in full text in any language, involving people with stroke who undergo telerehabilitation where exercise is the main component. Two reviewers will independently select studies and extract data, and disagreements will be resolved by consensus or a third reviewer. The results will be reported in a narrative form, using tables and figures to support them. DISCUSSION To implement this strategy within rehabilitation services, one of the first aspects to be solved is to ensure the safety of people. The results of this scoping review could contribute an information base for clinicians and decision-makers when designing remotely delivered exercise intervention programs. REGISTRATION NUMBER INPLASY202290104.
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Affiliation(s)
- Ruvistay Gutierrez-Arias
- Servicio de Medicina Física y Rehabilitación, Unidad de Kinesiología, Instituto Nacional del Tórax, Santiago, Chile
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
- * E-mail:
| | - Camila González-Mondaca
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Vinka Marinkovic-Riffo
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Marietta Ortiz-Puebla
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Fernanda Paillán-Reyes
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Pamela Seron
- Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile
- Departamento de Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
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17
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Fava-Felix PE, Bonome-Vanzelli SRC, Ribeiro FS, Santos FH. Systematic review on post-stroke computerized cognitive training: Unveiling the impact of confounding factors. Front Psychol 2022; 13:985438. [PMID: 36578681 PMCID: PMC9792177 DOI: 10.3389/fpsyg.2022.985438] [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: 07/08/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022] Open
Abstract
Background Stroke is a highly incapacitating disease that can lead to disabilities due to cognitive impairment, physical, emotional, and social sequelae, and a decrease in the quality of life of those affected. Moreover, it has been suggested that cognitive reserve (patients' higher levels of education or having a skilled occupation), for instance, can promote faster cognitive recovery after a stroke. For this reason, this review aims to identify the cognitive, functional, and behavioral effects of computerized rehabilitation in patients aged 50 years or older who had a stroke, considering cognitive reserve proxies. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-PRISMA, and performed the search for peer-reviewed randomized controlled trials without a date restriction on CINAHL, LILACS, PubMed, Scopus, and Web of Science databases were chosen. Results We screened 780 papers and found 19 intervention studies, but only 4 met the inclusion criteria and shared data. These studies included computerized tools for motor and cognitive rehabilitation in the experimental groups. In all studies, computerized training was combined with other interventions, such as standard therapy, occupational therapy, and aerobic exercises. There were 104 participants affected by ischemic or hemorrhagic stroke, predominantly male (57.69%), and all with cognitive impairment. Conclusion Despite a limited number of studies, varied methods and insufficient information available, schooling as a CR proxy combined with high-intensity computerized cognitive training was key to mediating cognitive improvement. The systematic review also identified that the associated ischemic stroke and shorter time of onset for rehabilitation contribute to the cognitive evolution of patients. Findings do not support a greater benefit of computerized cognitive training compared to conventional cognitive therapies. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=296193], identifier [CRD42022296193].
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Affiliation(s)
| | | | - Fabiana S. Ribeiro
- Department of Social Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Flávia H. Santos
- School of Psychology, University College Dublin, Dublin, Ireland
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18
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Tadayon H, Farzandipour M, Nabovati E, Akbari H, Masoud SA. Effect of mobile-based self-management application on stroke outcomes: a study protocol for triple blinded randomized controlled trial. BMC Med Inform Decis Mak 2022; 22:292. [DOI: 10.1186/s12911-022-02033-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Stroke is the main leading cause of long-term disabilities in the world. This protocol will be implemented for a study to evaluate the effects of an Android-based self-care application on patients with stroke.
Methods
The first stage will include the development of an android-based application using JAVA programming language for developing the user interface and ASP.NET Core for developing Web server. The second stage will be conducted using triple blinded randomized clinical trial (RCT). The sample size will include 60 patients with recent stroke and partial paralysis of limbs, who will be divided into two groups of intervention and control through permuted block randomization method. Patients in both groups will receive usual medical care, but those in the intervention group will also use an Android-based application for a period of two months. Outcomes will be assessed using valid and reliable questionnaires.
Discussion
The assessed outcomes will include stroke severity using National Institute of Health Stroke Scale (NIHSS) score, ability to perform activities of daily living using Barthel Index (BI) score, depression rate using Beck Depression Inventory (BDI-II) score, quality of life using EQ-5D-3L score, medication adherence using Modified Morisky Medication Adherence Scale (MMAS-8) score, patient satisfaction using Patient Satisfaction Questionnaire (PSQ) score and the number and type of complications in patients in two groups. These outcomes will be assessed at baseline, after two months and after three months from the beginning of the intervention. Intervention effects on the measured variables will also be evaluated using appropriate statistical tests based on the type of variable distribution. Potential consequences of the study might be the improvement of the measured variables in the intervention group compared to that of the control group. The expected results are that the intervention may significantly improve the status of the measured variables in the intervention group compared to that of the control group. If the outcomes of the intervention group do not change significantly compared to those of the control group, it can be due to different reasons. However, this can most likely be attributed to incorrect or insufficient use of the application by patients.
Trial registration: This protocol is registered in the Iranian registration of clinical trial (IRCT) on November 7, 2020 with the code IRCT20201015049037N1. URL: https://irct.ir/trial/51674
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19
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Guo QF, He L, Su W, Tan HX, Han LY, Gui CF, Chen Y, Jiang HH, Gao Q. Virtual reality for neurorehabilitation: A bibliometric analysis of knowledge structure and theme trends. Front Public Health 2022; 10:1042618. [PMID: 36438265 PMCID: PMC9684719 DOI: 10.3389/fpubh.2022.1042618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
Background As an emerging technology, virtual reality (VR) has been broadly applied in the medical field, especially in neurorehabilitation. The growing application of VR therapy promotes an increasing amount of clinical studies. In this paper, we present a bibliometric analysis of the existing studies to reveal the current research hotspots and guide future research directions. Methods Articles and reviews on the related topic were retrieved from the Science Citation Index Expanded of Web of Science Core Collection database. VOSviewer and Citespace software were applied to systematically analyze information about publications, countries, institutions, authors, journals, citations, and keywords from the included studies. Results A total of 1,556 papers published between 1995 and 2021 were identified. The annual number of papers increased gradually over the past three decades, with a peak publication year in 2021 (n = 276). Countries and institutions from North America and Western European were playing leading roles in publications and total citations. Current hotspots were focused on the effectiveness of VR therapy in cognitive and upper limb motor rehabilitation. The clusters of keywords contained the four targeted neurological diseases of VR, while the burst keywords represented that the latest studies were directed toward more defined types of VR therapy and greater study design. Conclusions Our study offers information regarding to the current hotspots and emerging trends in the VR for rehabilitation field. It could guide future research and application of VR therapy in neurorehabilitation.
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Affiliation(s)
- Qi-Fan Guo
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lin He
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Su
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Hui-Xin Tan
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lian-Yi Han
- Biostatistics Group, State Key Laboratory of Genetic Engineering, Greater Bay Area Institute of Precision Medicine (Guangzhou), Fudan University, Guangzhou, China
| | - Chen-Fan Gui
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Chen
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Han-Hong Jiang
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Gao
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Qiang Gao
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20
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Maresca G, Anchesi S, Bonanno L, Bramanti A, Carnazza L, Cimino V, Corallo F, Lo Buono V, Giambò FM, Latella D, Parasporo N, De Cola MC. Feasibility, Usability, and Customer Satisfaction of the Tele-COVID19 Project, Sicilian Model. Medicina (B Aires) 2022; 58:medicina58081110. [PMID: 36013577 PMCID: PMC9415370 DOI: 10.3390/medicina58081110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 11/21/2022] Open
Abstract
Background and Objectives: In March 2020, COVID-19 pandemic affected the world. All countries, to limit viral transmission, imposed quarantine. This emergency exerted personal, social, economic, and psychological impact on people. For health systems, was needed to create alternative care pathways. Telemedicine can be helpful to reduce isolation, provide health care services, and monitor virus infections. Italian regions, including Sicily, have activated telemedicine services for management of patients with COVID-19. Objective: The purpose of study is to describe a Sicilian telemedicine model for management of COVID-19 patients, showing results on feasibility, usability and quality of service and patient satisfaction. Materials and Methods: This is a descriptive exploratory study on a telemedicine service for residents in Messina infected by COVID-19. It included monitoring of vital signs and specialist consultations (i.e., doctor, psychologists, social workers, and nutritionist biologists). Results: More than twenty percent (23.8%) of participants used tele-monitoring and tele-counselling services; 14.3% were only telemonitored. Participants judged positively telemedicine service (30% were quiet and 50% were very satisfied), as well as tool (70% were quiet and 10% were very satisfied). Telemonitoring had a low agreement (10% were slightly satisfied and 50% were neutral); tele-counselling had a high rate of satisfaction (40% quiet and 60% were very satisfied). Conclusions: This study showed that telemedicine model for Sicilian population affected by COVID-19 was feasible, easy to use and appreciated by patients. Our promising results allow us to assume that if in Sicily there was a return of the emergency, we would be ready to manage it This system can be the solution to remote management of these patients, to reduce isolation, provide health services, and monitor virus infections. The use of this technology should encourage future research to change the health care system and provides opportunities to ensure health and care for oneself and others.
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Affiliation(s)
| | | | - Lilla Bonanno
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy
| | - Alessia Bramanti
- Department of Medicine, Surgery and Dentistry, Medical School of Salerno, University of Salerno, 84100 Salerno, Italy
| | - Lara Carnazza
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy
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21
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Nikolaev VA, Nikolaev AA. Recent trends in telerehabilitation of stroke patients: A narrative review. NeuroRehabilitation 2022; 51:1-22. [DOI: 10.3233/nre-210330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND: Stroke is the main reason for disabilities worldwide leading to motor dysfunction, spatial neglect and cognitive problems, aphasia, and other speech-language pathologies, reducing the life quality. To overcome disabilities, telerehabilitation (TR) has been recently introduced. OBJECTIVE: The aim of this review was to analyze current TR approaches for stroke patients’ recovery. METHODS: We searched 6 online databases from January 2018 to October 2021, and included 70 research and review papers in the review. We analyzed TR of 995 individuals, which was delivered synchronously and asynchronously. RESULTS: Findings show TR is feasible improving motor function, cognition, speech, and language communication among stroke patients. However, the dose of TR sessions varied significantly. We identified the following limitations: lack of equipment, software, and space for home-based exercises, insufficient internet capacity and speed, unavailability to provide hands on guidance, low digital proficiency and education, high cognitive demand, small samples, data heterogeneity, and no economic evaluation. CONCLUSIONS: The review shows TR is superior or similar to conventional rehabilitation in clinical outcomes and is used as complementary therapy or as alternative treatments. More importantly, TR provides access to rehabilitation services of a large number of patients with immobility, living in remote areas, and during COVID-19 pandemic or similar events.
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Affiliation(s)
- Vitaly A. Nikolaev
- Pirogov Russian National Research Medical University (Pirogov Medical University), Moscow, Russia
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Kumar A, Lall N, Pathak A, Joshi D, Mishra VN, Chaurasia RN, Singh VK. A questionnaire-based survey of acceptability and satisfaction of virtual neurology clinic during COVID-19 lockdown: a preliminary study. Acta Neurol Belg 2022; 122:1297-1304. [PMID: 35796999 PMCID: PMC9261122 DOI: 10.1007/s13760-022-02004-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/09/2022] [Indexed: 11/24/2022]
Abstract
Introduction Telemedicine during this pandemic acts as a lifeline for many non-COVID patients especially with chronic neurological diseases. The aim of present study was to evaluate cost effectiveness and level of satisfaction amongst patients from teleneurology outpatient department (OPD). Methods An online cross-sectional survey, having questions both in Hindi and English was conducted via telemedicine facility at Institute of Medical Sciences, Banaras Hindu University, Varanasi, India. Demographic variables, illness details, travel distance and time taken, travel expenditure, level of satisfaction and preferred choice among tele OPD versus in-person OPD once pandemic ends were recorded. Results Total 1388 patients filled the online COVID-19 teleneurology survey google form. Mean age was 39.21 ± 16.72 years. Majority (N = 824, 59%) were males. Six hundred (43%) patients’ educational qualification were ≤ 10th standard. Majority of patients (N = 840, 60.5%) belonged to the rural background. Headache (N = 424, 30.5%) followed by backache (N = 220, 16%), stroke (N = 176, 13%) and seizure (N = 148, 11%) were the common illnesses. Travel time of > 5 hours was saved in 496 (36%) patients and travel expenditure of > Rs100 in 796 (57%) patients. About 96% (N = 1332) felt satisfied with the treatment advice via teleconsultation. Discussion Teleneurology facility is not only feasible but also affordable and acceptable in various neurological conditions. The chief reasons being no waiting time, saving of travelling time and travel expenditure with good satisfaction.
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Affiliation(s)
- Anand Kumar
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, 221005, UP, India
| | - Neha Lall
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Science, Banaras Hindu University, Varanasi, 221005, India
| | - Abhishek Pathak
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, 221005, UP, India
| | - Deepika Joshi
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, 221005, UP, India
| | - Vijaya Nath Mishra
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, 221005, UP, India
| | - Rameshwar Nath Chaurasia
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, 221005, UP, India
| | - Varun Kumar Singh
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, 221005, UP, India.
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23
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Factors influencing the delivery of telerehabilitation for stroke: A systematic review. PLoS One 2022; 17:e0265828. [PMID: 35544471 PMCID: PMC9094559 DOI: 10.1371/journal.pone.0265828] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 03/08/2022] [Indexed: 11/24/2022] Open
Abstract
Objective Despite the available evidence regarding effectiveness of stroke telerehabilitation, there has been little focus on factors influencing its delivery or translation from the research setting into practice. There are complex challenges to embedding telerehabilitation into stroke services and generating transferable knowledge about scaling up and routinising this service model. This review aimed to explore factors influencing the delivery of stroke telerehabilitation interventions, including platforms, technical requirements, training, support, access, cost, usability and acceptability. Methods MEDLINE, EMBASE, CINAHL, Web of Science and Cochrane Library and Central Registry of Clinical Trials were searched to identify full-text articles of randomised controlled trials (RCTs) and protocols for RCTs published since a Cochrane review on stroke telerehabilitation services. A narrative synthesis was conducted, providing a comprehensive description of the factors influencing stroke telerehabilitation intervention delivery. Results Thirty-one studies and ten protocols of ongoing studies were included. Interventions were categorised as synchronous telerehabilitation (n = 9), asynchronous telerehabilitation (n = 11) and tele-support (n = 11). Telephone and videoconference were the most frequently used modes of delivery. Usability and acceptability with telerehabilitation were high across all platforms, although access issues and technical challenges may be potential barriers to the use of telerehabilitation in service delivery. Costs of intervention delivery and training requirements were poorly reported. Conclusions This review synthesises the evidence relating to factors that may influence stroke telerehabilitation intervention delivery at a crucial timepoint given the rapid deployment of telerehabilitation in response to the COVID-19 pandemic. It recommends strategies, such as ensuring adequate training and technical infrastructure, shared learning and consistent reporting of cost and usability and acceptability outcomes, to overcome challenges in embedding and routinising this service model and priorities for research in this area.
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Gibson E, Koh CL, Eames S, Bennett S, Scott AM, Hoffmann TC. Occupational therapy for cognitive impairment in stroke patients. Cochrane Database Syst Rev 2022; 3:CD006430. [PMID: 35349186 PMCID: PMC8962963 DOI: 10.1002/14651858.cd006430.pub3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Cognitive impairment is a frequent consequence of stroke and can impact on a person's ability to perform everyday activities. Occupational therapists use a range of interventions when working with people who have cognitive impairment poststroke. This is an update of a Cochrane Review published in 2010. OBJECTIVES To assess the impact of occupational therapy on activities of daily living (ADL), both basic and instrumental, global cognitive function, and specific cognitive abilities in people who have cognitive impairment following a stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase, four other databases (all last searched September 2020), trial registries, and reference lists. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials that evaluated an intervention for adults with clinically defined stroke and confirmed cognitive impairment. The intervention needed either to be provided by an occupational therapist or considered within the scope of occupational therapy practice as defined in the review. We excluded studies focusing on apraxia or perceptual impairments or virtual reality interventions as these are covered by other Cochrane Reviews. The primary outcome was basic activities of daily living (BADL) such as dressing, feeding, and bathing. Secondary outcomes were instrumental ADL (IADL) (e.g. shopping and meal preparation), community integration and participation, global cognitive function and specific cognitive abilities (including attention, memory, executive function, or a combination of these), and subdomains of these abilities. We included both observed and self-reported outcome measures. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies that met the inclusion criteria, extracted data, and assessed the certainty of the evidence. A third review author moderated disagreements if consensus was not reached. We contacted trial authors for additional information and data, where available. We assessed the certainty of key outcomes using GRADE. MAIN RESULTS: We included 24 trials from 11 countries involving 1142 (analysed) participants (two weeks to eight years since stroke onset). This update includes 23 new trials in addition to the one study included in the previous version. Most were parallel randomised controlled trials except for one cross-over trial and one with a two-by-two factorial design. Most studies had sample sizes under 50 participants. Twenty studies involved a remediation approach to cognitive rehabilitation, particularly using computer-based interventions. The other four involved a compensatory and adaptive approach. The length of interventions ranged from 10 days to 18 weeks, with a mean total length of 19 hours. Control groups mostly received usual rehabilitation or occupational therapy care, with a few receiving an attention control that was comparable to usual care; two had no intervention (i.e. a waiting list). Apart from high risk of performance bias for all but one of the studies, the risk of bias for other aspects was mostly low or unclear. For the primary outcome of BADL, meta-analysis found a small effect on completion of the intervention with a mean difference (MD) of 2.26 on the Functional Independence Measure (FIM) (95% confidence interval (CI) 0.17 to 4.22; P = 0.03, I2 = 0%; 6 studies, 336 participants; low-certainty evidence). Therefore, on average, BADL improved by 2.26 points on the FIM that ranges from 18 (total assist) to 126 (complete independence). On follow-up, there was insufficient evidence of an effect at three months (MD 10.00, 95% CI -0.54 to 20.55; P = 0.06, I2 = 53%; 2 studies, 73 participants; low-certainty evidence), but evidence of an effect at six months (MD 11.38, 95% CI 1.62 to 21.14, I2 = 12%; 2 studies, 73 participants; low-certainty evidence). These differences are below 22 points which is the established minimal clinically important difference (MCID) for the FIM for people with stroke. For IADL, the evidence is very uncertain about an effect (standardised mean difference (SMD) 0.94, 95% CI 0.41 to 1.47; P = 0.0005, I2 = 98%; 2 studies, 88 participants). For community integration, we found insufficient evidence of an effect (SMD 0.09, 95% CI -0.35 to 0.54; P = 0.68, I2 = 0%; 2 studies, 78 participants). There was an improvement of clinical importance in global cognitive functional performance after the intervention (SMD 0.35, 95% CI 0.16 to 0.54; P = 0.0004, I2 = 0%; 9 studies, 432 participants; low-certainty evidence), equating to 1.63 points on the Montreal Cognitive Assessment (MoCA) (95% CI 0.75 to 2.52), which exceeds the anchor-based MCID of the MoCA for stroke rehabilitation patients of 1.22. We found some effect for attention overall (SMD -0.31, 95% CI -0.47 to -0.15; P = 0.0002, I2 = 20%; 13 studies, 620 participants; low-certainty evidence), equating to a difference of 17.31 seconds (95% CI 8.38 to 26.24), and for executive functional performance overall (SMD 0.49, 95% CI 0.31 to 0.66; P < 0.00001, I2 = 74%; 11 studies, 550 participants; very low-certainty evidence), equating to 1.41 points on the Frontal Assessment Battery (range: 0-18). Of the cognitive subdomains, we found evidence of effect of possible clinical importance, immediately after intervention, for sustained visual attention (moderate certainty) equating to 15.63 seconds, for working memory (low certainty) equating to 59.9 seconds, and thinking flexibly (low certainty), compared to control. AUTHORS' CONCLUSIONS The effectiveness of occupational therapy for cognitive impairment poststroke remains unclear. Occupational therapy may result in little to no clinical difference in BADL immediately after intervention and at three and six months' follow-up. Occupational therapy may slightly improve global cognitive performance of a clinically important difference immediately after intervention, likely improves sustained visual attention slightly, and may slightly increase working memory and flexible thinking after intervention. There is evidence of low or very low certainty or insufficient evidence for effect on other cognitive domains, IADL, and community integration and participation. Given the low certainty of much of the evidence in our review, more research is needed to support or refute the effectiveness of occupational therapy for cognitive impairment after stroke. Future trials need improved methodology to address issues including risk of bias and to better report the outcome measures and interventions used.
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Affiliation(s)
- Elizabeth Gibson
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Chia-Lin Koh
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Sally Eames
- Community and Oral Health Innovation and Research Centre, Metro North Hospital and Health Service, Brisbane, Australia
| | - Sally Bennett
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Anna Mae Scott
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
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Contrada M, Arcuri F, Tonin P, Pignolo L, Mazza T, Nudo G, Pignataro ML, Quintieri M, Iozzi A, Cerasa A. Stroke Telerehabilitation in Calabria: A Health Technology Assessment. Front Neurol 2022; 12:777608. [PMID: 35126286 PMCID: PMC8815426 DOI: 10.3389/fneur.2021.777608] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/24/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Telerehabilitation (TR) is defined as a model of home service for motor and cognitive rehabilitation, ensuring continuity of care over time. TR can replace the traditional face-to-face approach as an alternative method of delivering conventional rehabilitation and applies to situations where the patient is unable to reach rehabilitation facilities or for low-income countries where outcomes are particularly poor. For this reason, in this study, we sought to demonstrate the feasibility and utility of a well-known TR intervention on post-stroke patients living in one of the poorest indebted regions of Italy, where the delivery of rehabilitation services is inconsistent and not uniform. Materials and Methods: Nineteen patients (13 male/6 female; mean age: 61.1 ± 8.3 years) with a diagnosis of first-ever ischemic (n = 14) or hemorrhagic stroke (n = 5), who had been admitted to the intensive rehabilitation unit (IRU) of the Institute S. Anna (Crotone, Italy), were consecutively enrolled to participate in this study. After the discharge, they continued the motor treatment remotely by means of a home-rehabilitation system. The entire TR intervention was performed (online and offline) using the Virtual Reality Rehabilitation System (VRRS) (Khymeia, Italy). All patients received intensive TR five times a week for 12 consecutive weeks (60 sessions, each session lasting about 1h). Results: We found a significant motor recovery after TR protocol as measured by the Barthel Index (BI); Fugl-Meyer motor score (FM) and Motricity Index (MI) of the hemiplegic upper limbs. Conclusions: This was the first demonstration that a well-defined virtual reality TR tool promotes motor and functional recovery in post-stroke patients living in a low-income Italian region, such as Calabria, characterized by a paucity of specialist rehabilitation services.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Antonio Cerasa
- S. Anna Institute, Crotone, Italy
- Institute for Biomedical Research and Innovation, National Research Council (IRIB-CNR), Messina, Italy
- Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, Cosenza, Italy
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Adcock AK, Haggerty T, Crawford A, Espinosa C. mHealth impact on secondary stroke prevention: a scoping review of randomized controlled trials among stroke survivors between 2010-2020. Mhealth 2022; 8:19. [PMID: 35449509 PMCID: PMC9014232 DOI: 10.21037/mhealth-21-27] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 11/11/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND A fundamental gap between clinical prevention and self-management awareness heightens the risk for stroke recurrence in approximately one-fourth of the highest risk stroke survivors annually. Secondary stroke prevention has the potential to be promoted by mobile health (mHealth) applications for effective real-world adoption of vascular risk factor mitigation. This scoping review aims to evaluate the impact of mHealth interventions and their effectiveness to reduce recurrent stroke rates among stroke survivors in randomized controlled trials (RCTs). METHODS Scoping review in Ovid Medline, Cochrane Library, CINAHL, and Scopus for RCT literature employing mHealth among stroke populations published in English from 2010 to November 19, 2020. Small or pilot studies that included randomized design were included. RESULTS A total of 352 abstracts met inclusion criteria; 31 full-text articles were assessed and 18 unique RCTs involving 1,453 patients ultimately fulfilled criteria. Twelve of 18 met the pre-defined primary outcome measure, including 2 studies evaluating feasibility. Eight of 18 only addressed recovery from index stroke deficits. Most outcomes focused on self-reported functional status, mood, quality of life or compliance with intervention; primary outcome was an objective metric in 4/18 (blood pressure readings, step number, obstructive sleep apnea support compliance). Intervention duration 2-12 months, with a median 9 weeks. CONCLUSIONS No high-quality evidence supporting mHealth applications to reduce recurrent stroke was found in this scoping review. Overall, most studies were relatively small, heterogenous, and employed subjective primary outcome measures. mHealth's potential as an effective tool for stroke stakeholders to reduce recurrent stroke rates has not been sufficiently demonstrated in this review. Future randomized studies are needed that explicitly evaluate stroke recurrence rate.
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Affiliation(s)
- Amelia K. Adcock
- Cerebrovascular Division, West Virginia University, Morgantown, WV, USA
| | - Treah Haggerty
- Obesity Medicine, West Virginia University, Morgantown, WV, USA
| | - Anna Crawford
- Health Sciences Library, West Virginia University, Morgantown, WV, USA
| | - Cristal Espinosa
- Masters of Clinical and Translational Science Program, West Virginia University, Morgantown, WV, USA
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Saragih ID, Tarihoran DETAU, Batubara SO, Tzeng HM, Lin CJ. Effects of telehealth interventions on performing activities of daily living and maintaining balance in stroke survivors: A systematic review and meta-analysis of randomised controlled studies. J Clin Nurs 2021; 31:2678-2690. [PMID: 34873756 DOI: 10.1111/jocn.16142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/01/2021] [Accepted: 11/09/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Stroke is one of the most common causes of disability worldwide. In recent years, diverse telehealth programmes for stroke survivors have suggested that this mode of rehabilitation could improve stroke survivors' abilities to perform activities of daily living (ADLs) and maintain balance. Although increasingly utilised in clinical and community settings, the effectiveness of telehealth interventions in stroke survivors remains inconclusive. This warrants investigation so that telehealth interventions are evidence-based and are not merely modalities of convenience. AIM To identify the effects of telehealth interventions on the ability to perform ADLs and maintain balance in stroke survivors. DESIGN A systematic literature review and meta-analysis were conducted in accordance with PRISMA guidelines. METHODS A systematic literature search was performed using seven databases for literature dated up to April 25, 2021. The revised Cochrane risk of bias tool for randomised trials was used to assess the methodological quality of the included studies. A meta-analysis was performed using a random-effects model to calculate the pooled effects of telehealth interventions. Stata 16.0 was used for the statistical analyses. RESULTS A total of 14 studies with 1,367 participants were included in the analysis. Overall, telehealth interventions were effective in improving stroke survivors' abilities to carry out their ADLs (standardised mean difference: .45; 95% confidence interval: .12 to .78); however, no significant effects were found on balance. CONCLUSION Telehealth interventions are beneficial for improving stroke survivors' performance of their ADLs. Future telehealth intervention trials should focus on identifying essential intervention delivery components that facilitate intervention adoption by clinicians and stroke survivors and sustain the positive effects on stroke survivors' performance of their ADLs in different settings. RELEVANCE TO CLINICAL PRACTICE It is essential to build flexibility in the telehealth-based intervention delivery protocol to meet individual stroke survivors' needs to motivate and enhance their ADL performance.
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Affiliation(s)
| | - Dame Elysabeth Tuty Arna Uly Tarihoran
- School of Nursing Faculty of Medical and Health Sciences and Assistant Professor, School of Nursing, Krida Wacana Christian University, UKRIDA, Jakarta, Indonesia, University of Auckland, New Zealand
| | | | - Huey-Ming Tzeng
- University of Texas, Medical Branch, School of Nursing, Galveston, Texas, USA
| | - Chia-Ju Lin
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Wilson PH, Rogers JM, Vogel K, Steenbergen B, McGuckian TB, Duckworth J. Home-based (virtual) rehabilitation improves motor and cognitive function for stroke patients: a randomized controlled trial of the Elements (EDNA-22) system. J Neuroeng Rehabil 2021; 18:165. [PMID: 34823545 PMCID: PMC8613521 DOI: 10.1186/s12984-021-00956-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background Home-based rehabilitation of arm function is a significant gap in service provision for adult stroke. The EDNA-22 tablet is a portable virtual rehabilitation-based system that provides a viable option for home-based rehabilitation using a suite of tailored movement tasks, and performance monitoring via cloud computing data storage. The study reported here aimed to compare use of the EDNA system with an active control (Graded Repetitive Arm Supplementary Program—GRASP training) group using a parallel RCT design. Methods Of 19 originally randomized, 17 acute-care patients with upper-extremity dysfunction following unilateral stroke completed training in either the treatment (n = 10) or active control groups (n = 7), each receiving 8-weeks of in-home training involving 30-min sessions scheduled 3–4 times weekly. Performance was assessed across motor, cognitive and functional behaviour in the home. Primary motor measures, collected by a blinded assessor, were the Box and Blocks Task (BBT) and 9-Hole Pegboard Test (9HPT), and for cognition the Montreal Cognitive Assessment (MoCA). Functional behaviour was assessed using the Stroke Impact Scale (SIS) and Neurobehavioural Functioning Inventory (NFI). Results One participant from each group withdrew for personal reasons. No adverse events were reported. Results showed a significant and large improvement in performance on the BBT for the more-affected hand in the EDNA training group, only (g = 0.90). There was a mild-to-moderate effect of training on the 9HPT for EDNA (g = 0.55) and control (g = 0.42) groups, again for the more affected hand. In relation to cognition, performance on the MoCA improved for the EDNA group (g = 0.70). Finally, the EDNA group showed moderate (but non-significant) improvement in functional behaviour on the SIS (g = 0.57) and NFI (g = 0.49). Conclusion A short course of home-based training using the EDNA-22 system can yield significant gains in motor and cognitive performance, over and above an active control training that also targets upper-limb function. Intriguingly, these changes in performance were corroborated only tentatively in the reports of caregivers. We suggest that future research consider how the implementation of home-based rehabilitation technology can be optimized. We contend that self-administered digitally-enhanced training needs to become part of the health literacy of all stakeholders who are impacted by stroke and other acquired brain injuries. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) Number: ACTRN12619001557123. Registered 12 November 2019, http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378298&isReview=true
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Affiliation(s)
- Peter H Wilson
- Healthy Brain and Mind Research Centre (HBMRC) and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia.
| | - Jeffrey M Rogers
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Karin Vogel
- Prince of Wales Hospital, Sydney, NSW, Australia
| | - Bert Steenbergen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Thomas B McGuckian
- Healthy Brain and Mind Research Centre (HBMRC) and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
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Cognitive telerehabilitation in neurological patients: systematic review and meta-analysis. Neurol Sci 2021; 43:847-862. [PMID: 34822030 PMCID: PMC8613517 DOI: 10.1007/s10072-021-05770-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/19/2021] [Indexed: 12/02/2022]
Abstract
Telerehabilitation (TR) seems to be an encouraging solution for the delivery of cognitive treatments in patients with neurological disorders. This study was aimed to analyze and synthesize the evidence on the efficacy of cognitive TR interventions in patients with neurological diseases, compared with conventional face-to-face rehabilitation. From a total of 4485 records, 9 studies met the inclusion criteria for qualitative analysis. At the end of the process, 7 studies remained for quantitative analysis. By comparing TR with face-to-face treatments for cognitive impairments, we assessed improvements in global cognitive domain (Mini Mental State Exam) (MD = −0.86; 95% CI −2.43, 0.72, I2 = 0%), in learning and memory domains (SMD = 0.26, 95% CI −0.22, 0.74, I2 = 24%), in verbal fluency (SMD = 0.08, 95% CI −0.47, 0.62, I2 = 0%), and in executive functions (i.e., problem-solving, central processing speed and working memory) (SMD = 0.38, 95% CI 0.06, 0.71, I2 = 0%). In all the included studies, improvement in the performance of the TR groups was comparable to that achieved through face-to-face intervention. Significant differences between those two modalities of providing treatments were observed for working memory and total executive function comparison, in favor of TR. The results of this study can sustain the efficacy of TR and its application for the treatment of neurological patients, especially when treated for executive function impairments.
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Telerehabilitation—A Viable Option for the Recovery of Post-Stroke Patients. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app112110116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
As the number of stroke survivors is continuously growing, with an important number suffering from consequent functional deficits, the rehabilitation field is facing more complex demands. Technological progress gives us the opportunity to remotely assist patients while they exercise at home through telerehabilitation (TR), addressing the problems of limited medical resources and staff, difficult transportation, or living a long distance from rehabilitation centers. In addition, TR is a way to provide continuity in long-term post-stroke recovery during the COVID-19 pandemic, which limits traveling and human interaction. While the implementation of TR is increasing, the biggest challenges are to raise patients’ acceptability of the new method and their motivation and engagement during the program. In this review, we aimed to find methods to address these challenges by identifying the patients who benefit the most from this therapy and efficiently organizing the space and technology used for telerehabilitation. User-friendly technologies and devices along with therapists’ constant support and feedback are some of the most important aspects that make TR an efficient intervention and an alternative to conventional therapy.
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Li W, Cheng X, Cai XF. The Design of a Track Monitoring System for Sports Injury Rehabilitation Training. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:1868440. [PMID: 34659679 PMCID: PMC8514885 DOI: 10.1155/2021/1868440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/16/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022]
Abstract
To realize the remote monitoring design in the process of rehabilitation training for athletes after an injury using computer technology, using Visual Studio 2010 development platform, and using ASP as the development language, NET as the development framework, the injury rehabilitation of injured athletes for dynamic monitoring of information management system, and its functions, system architecture and other detailed design. This article identified six laboratory workers outside the sample as experimental subjects. The experimental subjects' blood oxygen flow, degree, and rate were measured in the normal condition, and the pulse wave was recorded. Then, the upper and lower limbs rehabilitation training robot developed by the laboratory was used for about 15 minutes of rehabilitation training with 3-gear difficulty. The results show that the data measured by the system are the same as the data measured by the Lu Yue brand finger clip type YX301 blood oxygen saturation detector and meet the design requirements. Conclusion. The monitoring accuracy of the system is high, the resistance signal waveform is basically consistent with the actual waveform, and the monitoring effect is good.
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Affiliation(s)
- Wang Li
- Department of Physical Education, Huaiyin Institute of Technology, Huaian 223003, China
| | - Xin Cheng
- Department of Physical Education, Huaiyin Institute of Technology, Huaian 223003, China
| | - Xian Feng Cai
- Department of Physical Education, Huaiyin Institute of Technology, Huaian 223003, China
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Khoshrounejad F, Hamednia M, Mehrjerd A, Pichaghsaz S, Jamalirad H, Sargolzaei M, Hoseini B, Aalaei S. Telehealth-Based Services During the COVID-19 Pandemic: A Systematic Review of Features and Challenges. Front Public Health 2021; 9:711762. [PMID: 34350154 PMCID: PMC8326459 DOI: 10.3389/fpubh.2021.711762] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/21/2021] [Indexed: 01/11/2023] Open
Abstract
Background: As an ever-growing popular service, telehealth catered for better access to high-quality healthcare services. It is more valuable and cost-effective, particularly in the middle of the current COVID-19 pandemic. Accordingly, this study aimed to systematically review the features and challenges of telehealth-based services developed to support COVID-19 patients and healthcare providers. Methods: A comprehensive search was done for the English language and peer-reviewed articles published until November 2020 using PubMed and Scopus electronic databases. In this review paper, only studies focusing on the telehealth-based service to support COVID-19 patients and healthcare providers were included. The first author's name, publication year, country of the research, study objectives, outcomes, function type including screening, triage, prevention, diagnosis, treatment or follow-up, target population, media, communication type, guideline-based design, main findings, and challenges were extracted, classified, and tabulated. Results: Of the 5,005 studies identified initially, 64 met the eligibility criteria. The studies came from 18 countries. Most of them were conducted in the United States and China. Phone calls, mobile applications, videoconferencing or video calls, emails, websites, text messages, mixed-reality, and teleradiology software were used as the media for communication. The majority of studies used a synchronous communication. The articles addressed the prevention, screening, triage, diagnosis, treatment, and follow-up aspects of COVID-19 which the most common purpose was the patients' follow-up (34/64, 53%). Thirteen group barriers were identified in the literature, which technology acceptance and user adoption, concerns about the adequacy and accuracy of subjective patient assessment, and technical issues were the most frequent ones. Conclusion: This review revealed the usefulness of telehealth-based services during the COVID-19 outbreak and beyond. The features and challenges identified through the literature can be helpful for a better understanding of current telehealth approaches and pointed out the need for clear guidelines, scientific evidence, and innovative policies to implement successful telehealth projects.
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Affiliation(s)
- Farnaz Khoshrounejad
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahsa Hamednia
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ameneh Mehrjerd
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shima Pichaghsaz
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Jamalirad
- Department of Computer Engineering, Ayatollah Amoli University, Science and Research Branch, Amol, Iran
| | - Mahdi Sargolzaei
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Benyamin Hoseini
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shokoufeh Aalaei
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Ostrowska PM, Śliwiński M, Studnicki R, Hansdorfer-Korzon R. Telerehabilitation of Post-Stroke Patients as a Therapeutic Solution in the Era of the Covid-19 Pandemic. Healthcare (Basel) 2021; 9:654. [PMID: 34072939 PMCID: PMC8229171 DOI: 10.3390/healthcare9060654] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 01/11/2023] Open
Abstract
(1) Background: Due to the pandemic caused by the SARS-CoV-2 virus, rehabilitation centres have become less available for neurological patients. This is the result of efforts to physically distance society, to try to slow the spread of the pathogen. Health care facilities were mainly restricted to urgent cases, while most physiotherapy treatments, mainly for patients with chronic conditions, were suspended. Some countries have seen a reduction in acute stroke hospital admissions of from 50% to 80%. One solution to the above problem is the use of telerehabilitation in the home environment as an alternative to inpatient rehabilitation. (2) Aim of the study: The purpose of this review is to analyse the benefits and limitations of teletherapy in relation to the functional condition of post-stroke patients. (3) Methods: Selected publications from 2019 to 2021 on the telerehabilitation of stroke patients were reviewed. The review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. (4) Results: Studies have proven that teletherapy significantly improves the functional condition of post-stroke patients, resulting in improved quality of life and faster return to independence (while maintaining maximum possible precautions related to the SARS-CoV-2 virus pandemic). (5) Conclusions: Analysis of the study results showed comparable effectiveness of rehabilitation in the tele system to inpatient therapy. However, it should be emphasised that patients undergoing telerehabilitation must meet strict conditions to be eligible for this type of treatment program. However, the strength of the evidence itself supporting the effectiveness of this method ranks low due to the limited number of randomised control trials (RCT), small number of participants, and heterogeneous trials.
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Affiliation(s)
- Paulina Magdalena Ostrowska
- Department of Physiotherapy, Medical University of Gdańsk, 7 Dębinki Street, 80-211 Gdańsk, Poland; (M.Ś.); (R.S.); (R.H.-K.)
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Affiliation(s)
- Valeria Caso
- Cerebrovascular Diseases, Stroke Unit, Perugia Hospital, Perugia, Italy
| | - Antonio Federico
- Neurological Sciences, Department, Medicine, Surgery and Neurosciences, University of Siena, Viale Bracci 2, 53100, Siena, Italy.
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Upper Limb Rehabilitation Tools in Virtual Reality Based on Haptic and 3D Spatial Recognition Analysis: A Pilot Study. SENSORS 2021; 21:s21082790. [PMID: 33921036 PMCID: PMC8071461 DOI: 10.3390/s21082790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/06/2021] [Accepted: 04/13/2021] [Indexed: 11/17/2022]
Abstract
With aging, cerebrovascular diseases can occur more often. Stroke cases involve hemiplegia, which causes difficulties in performing activities of daily living. Existing rehabilitation treatments are based on the subjective evaluation of the therapist as the need for non-contact care arises; it is necessary to develop a system that can self-rehabilitate and offer objective analysis. Therefore, we developed rehabilitation tools that enable self-rehabilitation exercises in a virtual space based on haptics. Thirty adults without neurological damage were trained five times in a virtual environment, and the time, number of collisions, and coordinates were digitized and stored in real time. An analysis of variance (ANOVA) of the time and distance similarity changes revealed that as the number of rounds increased, no changes or increases occurred (p ≥ 0.05), and the collisions and paths were stable as the training progressed (p < 0.05). ANOVA showed a high correlation (0.90) with a decrease in the number of crashes and time required. It was meaningful to users when performing rehabilitation training more than four times and significantly impacted the analysis. This study analyzed the upper limb and cognitive rehabilitation of able-boded people in three-dimensional space in a virtual environment; the performance difficulty could be controlled through variations in rehabilitation models.
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Raso MG, Arcuri F, Liperoti S, Mercurio L, Mauro A, Cusato F, Romania L, Serra S, Pignolo L, Tonin P, Cerasa A. Telemonitoring of Patients With Chronic Traumatic Brain Injury: A Pilot Study. Front Neurol 2021; 12:598777. [PMID: 33868141 PMCID: PMC8047126 DOI: 10.3389/fneur.2021.598777] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 03/05/2021] [Indexed: 11/25/2022] Open
Abstract
Telehealth systems have shown success in the remote management of several neurological disorders, but there is a paucity of evidence in disorders of consciousness (DOC). In this study, we explore the effectiveness of a new telemonitoring system, for monitoring Vegetative State (VS) and Minimally Conscious State (MCS) patients. This was a prospective, mono-center randomized controlled study. We included only traumatic brain injury (TBI) patients who required long-term motor/cognitive assistance having a stable clinical condition. We examined their clinical evolution over ~4 years of the follow-up period. Twenty-two TBI patients were enrolled and equally divided into two groups: one telemonitored at home with our service and the second admitted to a standard long-stay hospitalization (LSH) program. Patients enrolled in the telehealth service (age: 49.9 ± 20.4; 45% female; diagnosis: 36% VS/64% MCS) were demographically and clinically-matched with those admitted to the LSH program (age: 55.1 ± 15; 18% female; diagnosis: 54% VS/46% MCS). Thirty-six percent of patients in the LSH program died before completing follow up evaluation with respect to 18% of death in the group of TBI patients telemonitored at home. At follow-up, patients in LSH and telemonitoring groups showed similar clinical progression, as measured by CRS-r, NCS, WHIM, and LCF scales, as well as by the number of medical complications (i.e., bedsores, infections). Finally, we estimated the total daily cost per patient. Severe TBI patients enrolled in the conventional LSH program cost 262€ every single day, whereas the cost per patient in the telehealth service resulted to be less expensive (93€). Here, we highlight that our telehealth monitoring service is as efficacious as in-person usual care to manage a severe neurological disorder such as TBI in a cost-effective way.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Antonio Cerasa
- Sant'Anna Institute, Crotone, Italy.,Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
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A Virtual Reality-Based Cognitive Telerehabilitation System for Use in the COVID-19 Pandemic. SUSTAINABILITY 2021. [DOI: 10.3390/su13042183] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The COVID-19 pandemic has changed people’s lives and the way in which certain services are provided. Such changes are not uncommon in healthcare services and they will have to adapt to the new situation by increasing the number of services remotely offered. Limited mobility has resulted in interruption of treatments that traditionally have been administered through face-to-face modalities, especially those related to cognitive impairments. In this telerehabilitation approach, both the patient and the specialist physician enter a virtual reality (VR) environment where they can interact in real time through avatars. A spaced retrieval (SR) task is implemented in the system to analyze cognitive performance. An experimental group (n = 20) performed the SR task in telerehabilitation mode, whereas a control group (n = 20) performed the SR task through a traditional face-to-face mode. The obtained results showed that it is possible to carry out cognitive rehabilitation processes through a telerehabilitation modality in conjunction with VR. The cost-effectiveness of the system will also contribute to making healthcare systems more efficient, overcoming both geographical and temporal limitations.
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Assenza C, Catania H, Antenore C, Gobbetti T, Gentili P, Paolucci S, Morelli D. Continuity of Care During COVID-19 Lockdown: A Survey on Stakeholders' Experience With Telerehabilitation. Front Neurol 2021; 11:617276. [PMID: 33519697 PMCID: PMC7838679 DOI: 10.3389/fneur.2020.617276] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/04/2020] [Indexed: 12/30/2022] Open
Abstract
Objective: To explore professionals', adult patients', and children's caregivers' perception and satisfaction with telerehabilitation during COVID-19 lockdown. Design: An observational transversal study on a web-based survey was conducted in order to explore participants' perception and satisfaction of telerehabilitation during COVID-19 lockdown. Setting: The study was conducted at our Outpatient Neurorehabilitation Service. Subjects: All rehabilitation professionals, adult patients, and children's caregivers who accepted telerehabilitation were recruited. Interventions: Participants had to respond to the Client Satisfaction Questionnaire-8 and to a purpose-built questionnaire on their perception and satisfaction of the service provided. Main Measures: Data were analyzed by qualitative statistics and logistic regression models. Results: All 144 caregivers, 25 adult patients, and 50 professionals reported a medium-high level of perception and a high level of satisfaction. Results showed a correlation among caregivers of children aged 0-3 and feeling overwhelmed with remote care (OR = 3.27), a low perception of telerehabilitation for enhancing goals (OR = 6.51), and a high perception of feeling helped in organizing daily activity (OR = 2.96). For caregivers of children aged over 6 years, changes in the therapy plan were related to a low perception of feeling in line with the in-person therapy (OR = 2.61 and OR = 9.61) and a low satisfaction (OR = 5.54 and OR = 4.97). Changes in therapy were related to concern (OR = 4.20). Caregivers under 40 and professionals showed a high probability to perceive telerehabilitation as supportive (OR = 2.27 and OR = 5.68). Level of experience with remote media was shown to influence perception and satisfaction. Interpretation: Telerehabilitation can be a useful practice both during a health emergency and in addition to in-presence therapy.
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Affiliation(s)
- Carla Assenza
- Neurorehabilitation Outpatient Department, Santa Lucia Foundation (Scientific Institute for Research and Health Care), Rome, Italy
| | - Hilenia Catania
- Neurorehabilitation Outpatient Department, Santa Lucia Foundation (Scientific Institute for Research and Health Care), Rome, Italy
| | - Clementina Antenore
- Neurorehabilitation Outpatient Department, Santa Lucia Foundation (Scientific Institute for Research and Health Care), Rome, Italy
| | - Tiziana Gobbetti
- Neurorehabilitation Outpatient Department, Santa Lucia Foundation (Scientific Institute for Research and Health Care), Rome, Italy
| | - Paola Gentili
- Neurorehabilitation Outpatient Department, Santa Lucia Foundation (Scientific Institute for Research and Health Care), Rome, Italy
| | - Stefano Paolucci
- Clinical Laboratory of Experimental Neurorehabilitation, Santa Lucia Foundation (Scientific Institute for Research and Health Care), Rome, Italy
| | - Daniela Morelli
- Neurorehabilitation Outpatient Department, Santa Lucia Foundation (Scientific Institute for Research and Health Care), Rome, Italy
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Maresca G, Maggio MG, De Luca R, Manuli A, Tonin P, Pignolo L, Calabrò RS. Tele-Neuro-Rehabilitation in Italy: State of the Art and Future Perspectives. Front Neurol 2020; 11:563375. [PMID: 33101176 PMCID: PMC7554582 DOI: 10.3389/fneur.2020.563375] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/26/2020] [Indexed: 11/20/2022] Open
Abstract
Current research suggests that the management of neurological diseases, both in adults and children, requires an ever increasing commitment of resources for the national healthcare system (NHS). In Italy, due to the aging of the population, increase in chronicity and morbidity of pathologies, and presence of islands and rural areas, health needs to be supported by innovative technologies. Telemedicine is a method of providing healthcare services at distance, remotely connecting health professionals and patients (or two professionals). In Italy, telemedicine is under development, and the NHS has not yet exploited and independently developed all the possibilities that telemedicine offers. Tele-rehabilitation consists in the use of information and communication technologies for the remote support of rehabilitation services. By allowing “home care,” it represents a valid support during the home rehabilitation process. This review is aimed at evaluating the role of telerehabilitation in Italy, with regard to the motor and cognitive rehabilitation programs applied to neurological pathologies, in both pediatric and adult patients. We screened the studies published between 2010 and 2019 on PubMed, Scopus, Cochrane, and Web of Sciences databases. Using the PICO model, the search combined the terms “telerehabilitation”; “neurological disorders”; “neurodegenerative disease,” “motor telerehabilitation”; “cognitive rehabilitation.” This review showed that telerehabilitation is a promising healthcare tool, as it guarantees continuity of care over time (after discharge) and in space (from hospital to patient's home), especially in patients with stroke. Furthermore, it allows to increase the frequency and intensity of rehabilitation programs, provide individualized rehabilitation treatment in comfortable and familiar environment for patient, monitor and evaluate patients' needs and progress, stimulate patient motivation and achieve better patient satisfaction, verify the results achieved by the patients, and potentially reduce the service costs. Unfortunately, almost all neurorehabilitation studies are characterized by small samples and wide variability of results, and would benefit from standardized procedures, aims and targets. Future telerehabilitation trials should include cost-effectiveness analysis associated with clinical outcomes to better assess the validity of this promising tool.
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Affiliation(s)
| | | | | | | | - Paolo Tonin
- S. Anna Institute, Research in Advanced Neurorehabilitation, Crotone, Italy
| | - Loris Pignolo
- S. Anna Institute, Research in Advanced Neurorehabilitation, Crotone, Italy
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Teleassistance for frail elderly people: A usability and customer satisfaction study. Geriatr Nurs 2020; 41:463-467. [DOI: 10.1016/j.gerinurse.2020.01.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 12/31/2022]
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Knepley KD, Mao JZ, Wieczorek P, Okoye FO, Jain AP, Harel NY. Impact of Telerehabilitation for Stroke-Related Deficits. Telemed J E Health 2020; 27:239-246. [PMID: 32326849 DOI: 10.1089/tmj.2020.0019] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Stroke is the leading cause of serious long-term disability in the United States. Barriers to rehabilitation include cost, transportation, lack of trained personnel, and equipment. Telerehabilitation (TR) has emerged as a promising modality to reduce costs, improve accessibility, and retain patient independence. TR allows providers to remotely administer therapy, potentially increasing access to underserved regions. Objectives: To describe types of stroke rehabilitation therapy delivered through TR and to evaluate whether TR is as effective as traditional in-person outpatient therapy in improving satisfaction and poststroke residual deficits such as motor function, speech, and disability. Methods: A literature search of the term "telerehabilitation and stroke" was conducted across three databases. Full-text articles with results pertaining to TR interventions were reviewed. Articles were scored for methodological quality using the PEDro scale. Results: Thirty-four articles with 1,025 patients were included. Types of TR included speech therapy, virtual reality (VR), robotic, community-based, goal setting, and motor training exercises. Frequently measured outcomes included motor function, speech, disability, and satisfaction. All 34 studies reported improvement from baseline after TR therapy. PEDro scores ranged from 2 to 8 with a mean of 4.59 ± 1.94 (on a scale of 0-10). Studies with control interventions, randomized allocation, and blinded assessment had significantly higher PEDro scores. All 15 studies that compared TR with traditional therapy showed equivalent or better functional outcomes. Home-based robotic therapy and VR were less costly than in-person therapy. Patient satisfaction with TR and in-person clinical therapy was similar. Conclusions: TR is less costly and equally as effective as clinic-based rehabilitation at improving functional outcomes in stroke patients. TR produces similar patient satisfaction. TR can be combined with other therapies, including VR, speech, and robotic assistance, or used as an adjuvant to direct in-person care.
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Affiliation(s)
- Kurt D Knepley
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Jennifer Z Mao
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA.,Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.,Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Peter Wieczorek
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Frederick O Okoye
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Abhi P Jain
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Noam Y Harel
- James J. Peters VA Medical Center Neurology, New York, New York, USA.,Neurology and Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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