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Zadrapova M, Mrázková E, Janura M, Strycek M, Cerny M. Influence of Rehabilitation Aid with Biofeedback on the Rehabilitation Process during Remote Home-Based Rehabilitation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9069. [PMID: 35897431 PMCID: PMC9330706 DOI: 10.3390/ijerph19159069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/09/2022] [Accepted: 07/20/2022] [Indexed: 12/02/2022]
Abstract
Ensuring the regularity and correctness of rehabilitation exercises in the home environment is a prerequisite for successful treatment. This clinical study compares balance therapy in the home environment on a conventional balance mat and an instrumented wobble board, with biofeedback supported by a rehabilitation scheme realized as web-based software that controls the course of rehabilitation remotely. The study included 55 patients with knee injuries. The control group consisted of 25 patients (12 females and 13 males, mean age 39 ± 12 years) and the study group of 30 patients (19 females and 11 males, mean age 40 ± 12 years). Treatment effects were compared using the ICS Balance Platform measurement system. Measurements showed significant differences in the change in ICS Balance platform parameters representing the dynamic stability of the patients. The dynamic stability improved more with the instrumented wobble board. The study did not show an influence of different methods of communication with patients during home-based rehabilitation.
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Affiliation(s)
- Mariana Zadrapova
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic; (M.Z.); (E.M.)
- Clinic of Rehabilitation and Physical Medicine, University Hospital of Ostrava, 70800 Ostrava, Czech Republic
| | - Eva Mrázková
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic; (M.Z.); (E.M.)
| | - Miroslav Janura
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, 77147 Olomouc, Czech Republic;
- Department of Rehabilitation, Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic
| | - Michal Strycek
- Department of Cybernetics and Biomedical Engineering, Faculty of Electrical Engineering and Computer Science, VSB—Technical University of Ostrava, 70800 Ostrava, Czech Republic;
| | - Martin Cerny
- Department of Cybernetics and Biomedical Engineering, Faculty of Electrical Engineering and Computer Science, VSB—Technical University of Ostrava, 70800 Ostrava, Czech Republic;
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Shah NV, Gold R, Dar QA, Diebo BG, Paulino CB, Naziri Q. Smart Technology and Orthopaedic Surgery: Current Concepts Regarding the Impact of Smartphones and Wearable Technology on Our Patients and Practice. Curr Rev Musculoskelet Med 2021; 14:378-391. [PMID: 34729710 PMCID: PMC8733100 DOI: 10.1007/s12178-021-09723-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW While limited to case reports or small case series, emerging evidence advocates the inclusion of smartphone-interfacing mobile platforms and wearable technologies, consisting of internet-powered mobile and wearable devices that interface with smartphones, in the orthopaedic surgery practice. The purpose of this review is to investigate the relevance and impact of this technology in orthopaedic surgery. RECENT FINDINGS Smartphone-interfacing mobile platforms and wearable technologies are capable of improving the patients' quality of life as well as the extent of their therapeutic engagement, while promoting the orthopaedic surgeons' abilities and level of care. Offered advantages include improvements in diagnosis and examination, preoperative templating and planning, and intraoperative assistance, as well as postoperative monitoring and rehabilitation. Supplemental surgical exposure, through haptic feedback and realism of audio and video, may add another perspective to these innovations by simulating the operative environment and potentially adding a virtual tactile feature to the operator's visual experience. Although encouraging in the field of orthopaedic surgery, surgeons should be cautious when using smartphone-interfacing mobile platforms and wearable technologies, given the lack of a current academic governing board certification and clinical practice validation processes.
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Affiliation(s)
- Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA.
| | - Richard Gold
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
- School of Medicine, Saint George's University, True Blue, West Indies, Grenada
| | - Qurratul-Ain Dar
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Carl B Paulino
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
- Department of Orthopaedic Surgery, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Qais Naziri
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
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Vourganas I, Stankovic V, Stankovic L, Kerr A. Factors That Contribute to the Use of Stroke Self-Rehabilitation Technologies: A Review. JMIR BIOMEDICAL ENGINEERING 2019. [DOI: 10.2196/13732] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background
Stroke is increasingly one of the main causes of impairment and disability. Contextual and empirical evidence demonstrate that, mainly due to service delivery constraints, but also due to a move toward personalized health care in the comfort of patients’ homes, more stroke survivors undergo rehabilitation at home with minimal or no supervision. Due to this trend toward telerehabilitation, systems for stroke patient self-rehabilitation have become increasingly popular, with many solutions recently proposed based on technological advances in sensing, machine learning, and visualization. However, by targeting generic patient profiles, these systems often do not provide adequate rehabilitation service, as they are not tailored to specific patients’ needs.
Objective
Our objective was to review state-of-the-art home rehabilitation systems and discuss their effectiveness from a patient-centric perspective. We aimed to analyze engagement enhancement of self-rehabilitation systems, as well as motivation, to identify the challenges in technology uptake.
Methods
We performed a systematic literature search with 307,550 results. Then, through a narrative review, we selected 96 sources of existing home rehabilitation systems and we conducted a critical analysis. Based on the critical analysis, we formulated new criteria to be used when designing future solutions, addressing the need for increased patient involvement and individualism. We categorized the criteria based on (1) motivation, (2) acceptance, and (3) technological aspects affecting the incorporation of the technology in practice. We categorized all reviewed systems based on whether they successfully met each of the proposed criteria.
Results
The criteria we identified were nonintrusive, nonwearable, motivation and engagement enhancing, individualized, supporting daily activities, cost-effective, simple, and transferable. We also examined the motivation method, suitability for elderly patients, and intended use as supplementary criteria. Through the detailed literature review and comparative analysis, we found no system reported in the literature that addressed all the set criteria. Most systems successfully addressed a subset of the criteria, but none successfully addressed all set goals of the ideal self-rehabilitation system for home use.
Conclusions
We identified a gap in the state-of-the-art in telerehabilitation and propose a set of criteria for a novel patient-centric system to enhance patient engagement and motivation and deliver better self-rehabilitation commitment.
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Büsching I, Sehle A, Stürner J, Liepert J. Using an upper extremity exoskeleton for semi-autonomous exercise during inpatient neurological rehabilitation- a pilot study. J Neuroeng Rehabil 2018; 15:72. [PMID: 30068372 PMCID: PMC6090973 DOI: 10.1186/s12984-018-0415-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 07/12/2018] [Indexed: 11/23/2022] Open
Abstract
Background Motor deficits are the most common symptoms after stroke. There is some evidence that intensity and amount of exercises influence the degree of improvement of functions within the first 6 months after the injury. The purpose of this pilot study was to evaluate the feasibility and acceptance of semi-autonomous exercises with an upper extremity exoskeleton in addition to an inpatient rehabilitation program. In addition, changes of motor functions were examined. Methods Ten stroke patients with a severe upper extremity paresis were included. They were offered to perform a semi-autonomous training with a gravity-supported, computer-enhanced device (Armeo®Spring, Hocoma AG) six times per week for 4 weeks. Feasibility was evaluated by weekly structured interviews with patients and supervisors. Motor functions were assessed before and after the training period using the Wolf Motor Function Test (WMFT). The Wilcoxon Signed Rank Test was used for assessing pre-post differences. The Pearson correlation co-efficient was used for correlating the number of completed sessions with the change in motor function. Acceptance of the device and the level of satisfaction with the training were determined by a questionnaire based on visual analogue scales. Results Neither patients nor supervisors reported side effects. However, one patient had to be excluded from analysis because of transportation difficulties from the ward to the treatment facility. Therefore, analysis was based on nine patients. On average, 13.2 (55%) sessions were realized. WMFT results showed significant improvements of proximal arm functions. The number of sessions correlated with the degree of shoulder force improvement. Patients rated the exercises to be motivating, and enjoyable and would continue using the Armeo®Spring at home if they had the opportunity. Conclusion Using an upper extremity exoskeleton for semi-autonomous training in an inpatient setting is feasible without side effects and is positively rated by the patients. It might further support the recovery of upper extremity function. Trial registration The trial was retrospectively registered. Registration number ISRCTN42633681.
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Affiliation(s)
- Imke Büsching
- Department of Neurorehabilitation, Kliniken Schmieder, Zum Tafelholz 8, D- 78476, Allensbach, Germany.,Reha-Klinik Bellikon, Mutschellenstrasse 2, 5454, Bellikon, Switzerland
| | - Aida Sehle
- Department of Neurorehabilitation, Kliniken Schmieder, Zum Tafelholz 8, D- 78476, Allensbach, Germany
| | - Jana Stürner
- Department of Neurorehabilitation, Kliniken Schmieder, Zum Tafelholz 8, D- 78476, Allensbach, Germany
| | - Joachim Liepert
- Department of Neurorehabilitation, Kliniken Schmieder, Zum Tafelholz 8, D- 78476, Allensbach, Germany.
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Wittmann F, Held JP, Lambercy O, Starkey ML, Curt A, Höver R, Gassert R, Luft AR, Gonzenbach RR. Self-directed arm therapy at home after stroke with a sensor-based virtual reality training system. J Neuroeng Rehabil 2016; 13:75. [PMID: 27515583 PMCID: PMC4982313 DOI: 10.1186/s12984-016-0182-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 07/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The effect of rehabilitative training after stroke is dose-dependent. Out-patient rehabilitation training is often limited by transport logistics, financial resources and a lack of motivation/compliance. We studied the feasibility of an unsupervised arm therapy for self-directed rehabilitation therapy in patients' homes. METHODS An open-label, single group study involving eleven patients with hemiparesis due to stroke (27 ± 31.5 months post-stroke) was conducted. The patients trained with an inertial measurement unit (IMU)-based virtual reality system (ArmeoSenso) in their homes for six weeks. The self-selected dose of training with ArmeoSenso was the principal outcome measure whereas the Fugl-Meyer Assessment of the upper extremity (FMA-UE), the Wolf Motor Function Test (WMFT) and IMU-derived kinematic metrics were used to assess arm function, training intensity and trunk movement. Repeated measures one-way ANOVAs were used to assess differences in training duration and clinical scores over time. RESULTS All subjects were able to use the system independently in their homes and no safety issues were reported. Patients trained on 26.5 ± 11.5 days out of 42 days for a duration of 137 ± 120 min per week. The weekly training duration did not change over the course of six weeks (p = 0.146). The arm function of these patients improved significantly by 4.1 points (p = 0.003) in the FMA-UE. Changes in the WMFT were not significant (p = 0.552). ArmeoSenso based metrics showed an improvement in arm function, a high number of reaching movements (387 per session), and minimal compensatory movements of the trunk while training. CONCLUSIONS Self-directed home therapy with an IMU-based home therapy system is safe and can provide a high dose of rehabilitative therapy. The assessments integrated into the system allow daily therapy monitoring, difficulty adaptation and detection of maladaptive motor patterns such as trunk movements during reaching. TRIAL REGISTRATION Unique identifier: NCT02098135 .
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Affiliation(s)
- Frieder Wittmann
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Jeremia P Held
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Michelle L Starkey
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | | | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Andreas R Luft
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital Zurich, Zurich, Switzerland.,Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Roman R Gonzenbach
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital Zurich, Zurich, Switzerland
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Marschollek M, Becker M, Bauer JM, Bente P, Dasenbrock L, Elbers K, Hein A, Kolb G, Künemund H, Lammel-Polchau C, Meis M, Meyer Zu Schwabedissen H, Remmers H, Schulze M, Steen EE, Thoben W, Wang J, Wolf KH, Haux R. Multimodal activity monitoring for home rehabilitation of geriatric fracture patients--feasibility and acceptance of sensor systems in the GAL-NATARS study. Inform Health Soc Care 2015; 39:262-71. [PMID: 25148561 DOI: 10.3109/17538157.2014.931852] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Demographic change will lead to a diminishing care workforce faced with rising numbers of older persons in need of care, suggesting meaningful use of health-enabling technologies, and home monitoring in particular, to contribute to supporting both the carers and the persons in need. OBJECTIVES We present and discuss the GAL-NATARS study design along with first results regarding technical feasibility of long-term home monitoring and acceptance of different sensor modalities. METHODS Fourteen geriatric participants with mobility-impairing fractures were recruited in three geriatric clinics. Following inpatient geriatric rehabilitation, their homes were equipped with ambient sensor components for three months. Additionally, a wearable accelerometer was employed. Technical feasibility was assessed by system and component downtimes, technology acceptance by face-to-face interviews. RESULTS The overall system downtime was 6%, effected by two single events, but not by software failures. Technology acceptance was rated very high by all participants at the end of the monitoring periods, and no interference with their social lives was reported. DISCUSSION AND CONCLUSIONS Home-monitoring technologies were well-accepted by our participants. The information content of the data still needs to be evaluated with regard to clinical outcome parameters as well as the effect on the quality of life before recommending large-scale implementations.
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Affiliation(s)
- Michael Marschollek
- Peter L. Reichertz Institute for Medical Informatics, University of Braunschweig - Institute of Technology and Hannover Medical School , Hannover , Germany
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González A, Hayashibe M, Bonnet V, Fraisse P. Whole body center of mass estimation with portable sensors: using the statically equivalent serial chain and a Kinect. SENSORS (BASEL, SWITZERLAND) 2014; 14:16955-71. [PMID: 25215943 PMCID: PMC4208208 DOI: 10.3390/s140916955] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 08/05/2014] [Accepted: 08/07/2014] [Indexed: 11/30/2022]
Abstract
The trajectory of the whole body center of mass (CoM) is useful as a reliable metric of postural stability. If the evaluation of a subject-specific CoM were available outside of the laboratory environment, it would improve the assessment of the effects of physical rehabilitation. This paper develops a method that enables tracking CoM position using low-cost sensors that can be moved around by a therapist or easily installed inside a patient's home. Here, we compare the accuracy of a personalized CoM estimation using the statically equivalent serial chain (SESC) method and measurements obtained with the Kinect to the case of a SESC obtained with high-end equipment (Vicon). We also compare these estimates to literature-based ones for both sensors. The method was validated with seven able-bodied volunteers for whom the SESC was identified using 40 static postures. The literature-based estimation with Vicon measurements had a average error 24.9 ± 3.7 mm; this error was reduced to 12.8 ± 9.1 mm with the SESC identification. When using Kinect measurements, the literature-based estimate had an error of 118.4 ± 50.0 mm, while the SESC error was 26.6 ± 6.0 mm. The subject-specific SESC estimate using low-cost sensors has an equivalent performance as the literature-based one with high-end sensors. The SESC method can improve CoM estimation of elderly and neurologically impaired subjects by considering variations in their mass distribution.
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Affiliation(s)
- Alejandro González
- INRIA (Institut National de Recherche en Informatique et en Automatique), DEMAR Team, Montpellier 34095, France.
| | - Mitsuhiro Hayashibe
- INRIA (Institut National de Recherche en Informatique et en Automatique), DEMAR Team, Montpellier 34095, France.
| | - Vincent Bonnet
- Movement to Health (M2H) Laboratory, EuroMov, University of Montpellier 1, Montpellier 34090, France.
| | - Philippe Fraisse
- INRIA (Institut National de Recherche en Informatique et en Automatique), DEMAR Team, Montpellier 34095, France.
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