Review: How Can Intelligent Robots and Smart Mechatronic Modules Facilitate Remote Assessment, Assistance, and Rehabilitation for Isolated Adults With Neuro-Musculoskeletal Conditions?

User-Centred Design to Inform Requirements for a Remotely Administered Hybrid Functional Test (RAHFT) Protocol

PURPOSE

Functional testing is important to inform return-to-work (RTW), but new paradigms are needed to increase access and availability of testing. Our purpose was to deploy a user centred design approach to collect, describe, and interpret end-user feedback (clinicians and patients) to inform functional requirements for a remotely administered hybrid functional test (RAHFT) protocol.

METHODS

Twenty participants (10 clinicians and 10 patients) were interviewed about existing in-person functional testing and about perceptions of prospective remotely administered functional testing protocols. Interview data were synthesized, where findings informed a focus group with functional testing clinician experts to identify functional design requirements for a RAHFT protocol.

RESULTS

Patients agreed that access to equipment and technology, safety, and personal connections were important requirements for a functional testing protocol. Expert clinicians emphasized that a RAHFT should provide valid information to inform treatment planning and RTW outcome decisions, inclusive of opportunities to capture subjective and performance-based information.

CONCLUSIONS

RAHFT protocols can play an important role towards early and safe RTW. RAHFT protocols will increase availability and improve access for workers that cannot easily attend a clinic for in-person testing. Findings from this study provide functional requirements that should be considered when designing RAHFT protocols.

Effectiveness of remote neuropsychological interventions: A systematic review

OBJECTIVE

Remote healthcare services is an upgrowing dynamic field that has been used to reduce potential disease spread and prevent overloading of the healthcare system during COVID-19 pandemic. The need for online interventions during the pandemic required immediate response with sometimes inadequate preparation. The aim of the present study is to investigate the effectiveness of remote healthcare services in the field of neuropsychological interventions.

METHODS

A systematic literature search was conducted in the electronic databases of PubMed, PsychINFO and Google Scholar. The main search terms were "remote neuropsychological intervention or training." The included articles were RCT studies published in English, examining the effectiveness of remote healthcare services in neuropsychological interventions for adults with neurological disease diagnoses. Studies involving psychiatric disorders were excluded. Two reviewers assessed the quality of the studies and risk of bias using the PEDro Scale.

RESULTS

A total of 10 studies with 2.221 participants were included. All studies concluded that remote healthcare intervention programs can be feasible, safe and effective in the rehabilitation process of neurological diseases.

DISCUSSION

The present review demonstrated that the domains of neuropsychology have opportunities to forge ahead beyond traditional settings and have the ability to adapt to constantly changing environmental conditions with a view to providing patient care. Health policy plans should therefore be reformulated to include these needs in accordance with the social and cultural context of implementation.

Digital Technology Enablers of Tele-Neurorehabilitation in Pre- and Post-COVID-19 Pandemic Era - A Scoping Review

Neurorehabilitation (NR), a major component of neurosciences, is the process of restoring a patient's damaged/disorganized neurological function, through training, therapy, and education, while focusing on patient's independence and well-being. Since the advent of the COVID-19 pandemic, various applications of telecare and telehealth services surged drastically and became an integral part of current clinical practices. Tele-Neurorehabilitation (TNR) is one of such applications. When rehabilitation services were disrupted globally due to lockdown and travel restrictions, the importance of TNR was recognized, especially in developed, low, and middle-income countries. With exponential deployment of telehealth interventions in neurosciences, TNR has become a distinct stand-alone sub-specialty of neurosciences and telehealth. Digital technologies, such as wearables, robotics, and Virtual Reality (VR) have enabled TNR to improve the quality of patients' lives. Providing NR remotely using digital technologies and customized digital devices is now a reality, and likely to be the new norm soon. This article provides an overview of the needs, utilization, and deployment of TNR, and focuses on digital technology enablers of TNR in pre- and post-COVID-19 pandemic era.

Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice on telerehabilitation. The European PRM position (UEMS PRM Section)

INTRODUCTION

The evidence on the utility and effectiveness of rehabilitation interventions delivered via telerehabilitation is growing rapidly. Telerehabilitation is expected to have a key role in rehabilitation in the future.

AIM

The aim of this evidence-based position paper (EBPP) is to improve PRM physicians' professional practice in telerehabilitation to be delivered to improve functioning and to reduce activity limitations and/or participation restrictions in individuals with a variety of disabling health conditions.

METHODS

To produce recommendations for PRM physicians on telerehabilitation, a systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section.

RESULTS

The systematic literature review is reported together with the 32 recommendations resulting from the Delphi procedure.

CONCLUSIONS

It is recommended that PRM physicians deliver rehabilitation services remotely, via digital means or using communication technologies to eligible individuals, whenever required and feasible in a variety of health conditions in favor of the patient and his/her family, based on evidence of effectiveness and in compliance with relevant regulations. This EBPP represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians in telerehabilitation.

The Role and Importance of Using Sensor-Based Devices in Medical Rehabilitation: A Literature Review on the New Therapeutic Approaches

Due to the growth of sensor technology, more affordable integrated circuits, and connectivity technologies, the usage of wearable equipment and sensing devices for monitoring physical activities, whether for wellness, sports monitoring, or medical rehabilitation, has exploded. The current literature review was performed between October 2022 and February 2023 using PubMed, Web of Science, and Scopus in accordance with P.R.I.S.M.A. criteria. The screening phase resulted in the exclusion of 69 articles that did not fit the themes developed in all subchapters of the study, 41 articles that dealt exclusively with rehabilitation and orthopaedics, 28 articles whose abstracts were not visible, and 10 articles that dealt exclusively with other sensor-based devices and not medical ones; the inclusion phase resulted in the inclusion of 111 articles. Patients who utilise sensor-based devices have several advantages due to rehabilitating a missing component, which marks the accomplishment of a fundamental goal within the rehabilitation program. As technology moves faster and faster forward, the field of medical rehabilitation has to adapt to the time we live in by using technology and intelligent devices. This means changing every part of rehabilitation and finding the most valuable and helpful gadgets that can be used to regain lost functions, keep people healthy, or prevent diseases.

Guideline on multimodal rehabilitation for patients with post-intensive care syndrome

BACKGROUND

Intensive Care Unit (ICU) survivors often experience several impairments in their physical, cognitive, and psychological health status, which are labeled as post-intensive care syndrome (PICS). The aim of this work is to develop a multidisciplinary and -professional guideline for the rehabilitative therapy of PICS.

METHODS

A multidisciplinary/-professional task force of 15 healthcare professionals applied a structured, evidence-based approach to address 10 scientific questions. For each PICO-question (Population, Intervention, Comparison, and Outcome), best available evidence was identified. Recommendations were rated as "strong recommendation", "recommendation" or "therapy option", based on Grading of Recommendations, Assessment, Development and Evaluation principles. In addition, evidence gaps were identified.

RESULTS

The evidence resulted in 12 recommendations, 4 therapy options, and one statement for the prevention or treatment of PICS.

RECOMMENDATIONS

early mobilization, motor training, and nutrition/dysphagia management should be performed. Delirium prophylaxis focuses on behavioral interventions. ICU diaries can prevent/treat psychological health issues like anxiety and post-traumatic stress disorders. Early rehabilitation approaches as well as long-term access to specialized rehabilitation centers are recommended. Therapy options include additional physical rehabilitation interventions. Statement: A prerequisite for the treatment of PICS are the regular and repeated assessments of the physical, cognitive and psychological health in patients at risk for or having PICS.

CONCLUSIONS

PICS is a variable and complex syndrome that requires an individual multidisciplinary, and multiprofessional approach. Rehabilitation of PICS should include an assessment and therapy of motor-, cognitive-, and psychological health impairments.

Artificial Intelligence for skeleton-based physical rehabilitation action evaluation: A systematic review

Performing prescribed physical exercises during home-based rehabilitation programs plays an important role in regaining muscle strength and improving balance for people with different physical disabilities. However, patients attending these programs are not able to assess their action performance in the absence of a medical expert. Recently, vision-based sensors have been deployed in the activity monitoring domain. They are capable of capturing accurate skeleton data. Furthermore, there have been significant advancements in Computer Vision (CV) and Deep Learning (DL) methodologies. These factors have promoted the solutions for designing automatic patient's activity monitoring models. Then, improving such systems' performance to assist patients and physiotherapists has attracted wide interest of the research community. This paper provides a comprehensive and up-to-date literature review on different stages of skeleton data acquisition processes for the aim of physio exercise monitoring. Then, the previously reported Artificial Intelligence (AI) - based methodologies for skeleton data analysis will be reviewed. In particular, feature learning from skeleton data, evaluation, and feedback generation for the purpose of rehabilitation monitoring will be studied. Furthermore, the associated challenges to these processes will be reviewed. Finally, the paper puts forward several suggestions for future research directions in this area.

Roboethics in Remote Human Interactions and Rehabilitative Therapeutics

Global aging, the need for continuous high-quality services, and the recent COVID-19 pandemic have caused many sectors to reduce in-person contact between individuals where possible, and to instead use remote communication technology. With increased robot use replacing in-person interventions, ethical considerations arise. The benefits of robotic technology must be weighed against the possibility of harm to humans. The first rules of roboethics were written by Isaac Asimov in 1942, but these pre-date the range of robotic applications used today. There is no central agency for oversight in Canada, although universities and funding organizations have developed guidelines. Roboethical considerations include data use and privacy, the common good, and safety. Humans may potentially form emotional bonds with robots. Loss of jobs to automation is also a concern, particularly when many workers have suffered job losses due to the pandemic. Some health care services have switched to a remote care model, to reduce the spread of COVID-19. Remote hand rehabilitation of patients with brain injury is possible with iManus. Using a portable smart-glove technology, patients practice rehabilitative hand movements that are analyzed remotely through a sensor that offers instantaneous feedback. A therapist monitors their patient’s progress remotely and designs individualized programs. This technology benefits humanity by improving access to care for patients globally. The importance of data security and privacy is emphasized. As patient progress will be monitored by a human (a therapist), the safety of iManus is not a concern. The principles discussed in this paper can help researchers and engineers design ethical robotics in remote health care settings.

Healthcare Workers’ Point of View on Medical Robotics During COVID-19 Pandemic – A Scoping Review

COVID-19 affected how healthcare workers interact with patients. Medical technology and robotics are developed in hospital settings to limit human contact. The aim of this review is to elucidate what kind of medical robotics is required for healthcare workers during COVID-19 pandemic. This review was obtained from electronic databases such as Google Scholar, PubMed, EBSCO, and Cochrane reviews were searched for articles using keywords such as “healthcare professional” OR “health worker” AND “COVID-19” AND “robot application” OR “robotics” OR “health technology” AND “needs assessment” OR “expectation” OR “perception” published during 2020 to 2021. Inclusion criteria were full-text articles related to assessment of healthcare workers’ need for medical robotics during COVID-19 pandemics. Exclusion criteria included abstracts, duplicate articles, blogs, news articles, promotional brochures, and conference proceedings. A total of 13,692 articles were identified through the search engines (PubMed 179, Cochrane Library 1300, EBSCO 13, Google Scholar 12,200). Five full-text articles fulfilled the inclusion criteria. Determining robotic functions is important to healthcare workers who will be user of such medical technology. This review divided robotic functions into medical, operational, movement, and social functions. Healthcare workers’ demands for robotics were also influenced by the types of robots, such as examination robots, robot-based sample test and medicine production, surgery and rehabilitation robots, disinfection and cleaning robots, delivery and logistic robot, telemedicine, and telepresence robots. Medical robotics is required for healthcare workers during the COVID-19 pandemic. The highest demands for medical robotics functions include cardiac measurements and oxygen saturation monitoring (medical functions); examination record delivery, video and image play, and medical information delivery (operational functions); and the ability to recognize and avoid obstacles (movement functions). Disinfection and cleaning robots were the type of robots with the highest demand among healthcare workers.

Human-like tele-health robotics for older adults – A preliminary feasibility trial and vision

Introduction

The global increase of the aging population presents major challenges to healthcare service delivery. Further, the COVID-19 pandemic exposed older adults’ vulnerability to rapid deterioration of health when deprived of access to care due to the need for social distancing. Robotic technology advancements show promise to improve provision of quality care, support independence for patients and augment the capabilities of clinicians to perform tasks remotely.

Aim

This study explored the feasibility and end-user acceptance of using a novel human-like tele-robotic system with touch feedback to conduct a remote medical examination and deliver safe care.

Method

Testing of a remotely controlled robot was conducted with in-person clinician support to gather ECG readings of 11 healthy participants through a digital medical device. Post-study feedback about the system and the remote examinations conducted was obtained from study participants and study clinicians.

Results

The findings demonstrated the system’s capability to support remote examination of participants, and validated the system’s perceived acceptability by clinicians and end-users who all reported feeling safe interacting with the robot and 72% preferred remote robotic exam over in-person examination.

Conclusion

This paper discusses potential implications of robot-assisted telehealth for patients including older adults who are precluded from having in-person medical visits due to geographic distance or mobility, and proposes next steps for advancing robot-assisted telehealth delivery.

Telerehabilitation—A Viable Option for the Recovery of Post-Stroke Patients

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.

The Social Robot and the Digital Physiotherapist: Are We Ready for the Team Play?

Motivation: We are witnessing two phenomena. The first is that the physiotherapist is increasingly becoming a figure that must interact with Digital Health. On the other hand, social robots through research are improving more and more in the aspects of social interaction thanks also to artificial intelligence and becoming useful in rehabilitation processes. It begins to become strategic to investigate the intersections between these two phenomena. Objective: Therefore, we set ourselves the goal of investigating the consensus and opinion of physiotherapists around the introduction of social robots in clinical practice both in rehabilitation and assistance. Procedure: An electronic survey has been developed focused on social robot-based rehabilitation and assistance and has been submitted to subjects focused on physiotherapy sciences to investigate their opinion and their level of consent regarding the use of the social robot in rehabilitation and assistance. Two samples of subjects were recruited: the first group (156 participating subjects, 79 males, 77 females, mean age 24.3 years) was in the training phase, and the second (167 participating subjects, 86 males, 81 females, mean age 42.4 years) group was involved in the work processes. An electronic feedback form was also submitted to investigate the acceptance of the proposed methodology. Results: The survey showed a consistency of the results between the two samples from which interesting considerations emerge. Contrary to stereotypes that report how AI-based devices put jobs at risk, physiotherapists are not afraid of these devices. The subjects involved in the study believe the following: (a) social robots can be reliable co-workers but will remain a complementary device; (b) their role will be of the utmost importance as an operational manager in their use and in performance monitoring; (c) these devices will allow an increase in working capacity and facilitate integration. All those involved in the study believe that the proposed electronic survey has proved to be a useful and effective tool that can be useful as a periodic monitoring tool and useful for scientific societies. Conclusions: The evolution of social robots represents an unstoppable process as does the increase in the aging of the population. Stakeholders must not look with suspicion toward these devices, which can represent an important resource, but rather invest in monitoring and consensus training initiatives.

Smart Health-Enhanced Early Mobilisation in Intensive Care Units

Critically ill patients that stay in Intensive Care Units (ICU) for long periods suffer from Post-Intensive Care Syndrome or ICU Acquired Weakness, whose effects can decrease patients' quality of life for years. To prevent such issues and aiming at shortening intensive care treatments, Early Mobilisation (EM) has been proposed as an encouraging technique: the literature includes numerous examples of the benefits of EM on the prevention of post-operative complications and adverse events. However, the appropriate application of EM programmes entails the use of scarce resources, both human and technical. Information and Communication Technologies can play a key role in reducing cost and improving the practice of EM. Although there is rich literature on EM practice and its potential benefits, there are some barriers that must be overcome, and technology, i.e., the use of sensors, robotics or information systems, can contribute to that end. This article reviews the literature and analyses on the use of technology in the area of EM, and moreover, it proposes a smart health-enhanced scenario.