Implementation and Assessment of an Intelligent Motor Tele-Rehabilitation Platform

Technological advances in lower-limb tele-rehabilitation: A review of literature

Tele-rehabilitation is a healthcare practice that leverages technology to provide rehabilitation services remotely to individuals in their own homes or other locations. With advancements in remote monitoring and Artificial Intelligence, automatic tele-rehabilitation systems that can measure joint angles, recognize exercises, and provide feedback based on movement analysis are being developed. Such platforms can offer valuable information to clinicians for improved care planning. However, with various methods and sensors being used, understanding their pros, cons, and performance is important. This paper reviews and compares the performance of recent vision-based, wearable, and pressure-sensing technologies used in lower limb tele-rehabilitation systems over the past 10 years (from 2014 to 2023). We selected studies that were published in English and focused on joint angle estimation, activity recognition, and exercise assessment. Vision-based approaches were the most common, accounting for 42% of studies. Wearable technology followed at approximately 37%, and pressure-sensing technology appeared in 21% of studies. Identified gaps include a lack of uniformity in reported performance metrics and evaluation methods, a need for cross-subject validation, inadequate testing with patients and older adults, restricted sets of exercises evaluated, and a scarcity of comprehensive datasets on lower limb exercises, especially those involving movements while lying down.

Design and Validation of Vision-Based Exercise Biofeedback for Tele-Rehabilitation

Tele-rehabilitation has the potential to considerably change the way patients are monitored from their homes during the care process, by providing equitable access without the need to travel to rehab centers or shoulder the high cost of personal in-home services. Developing a tele-rehab platform with the capability of automating exercise guidance is likely to have a significant impact on rehabilitation outcomes. In this paper, a new vision-based biofeedback system is designed and validated to identify the quality of performed exercises. This new system will help patients to refine their movements to get the most out of their plan of care. An open dataset was used, which consisted of data from 30 participants performing nine different exercises. Each exercise was labeled as "Correctly" or "Incorrectly" executed by five clinicians. We used a pre-trained 3D Convolution Neural Network (3D-CNN) to design our biofeedback system. The proposed system achieved average accuracy values of 90.57% ± 9.17% and 83.78% ± 7.63% using 10-Fold and Leave-One-Subject-Out (LOSO) cross validation, respectively. In addition, we obtained average F1-scores of 71.78% ± 5.68% using 10-Fold and 60.64% ± 21.3% using LOSO validation. The proposed 3D-CNN was able to classify the rehabilitation videos and feedback on the quality of exercises to help users modify their movement patterns.

The Potential of Computer Vision-Based Marker-Less Human Motion Analysis for Rehabilitation

Background

Several factors, including the aging population and the recent corona pandemic, have increased the need for cost effective, easy-to-use and reliable telerehabilitation services. Computer vision-based marker-less human pose estimation is a promising variant of telerehabilitation and is currently an intensive research topic. It has attracted significant interest for detailed motion analysis, as it does not need arrangement of external fiducials while capturing motion data from images. This is promising for rehabilitation applications, as they enable analysis and supervision of clients' exercises and reduce clients' need for visiting physiotherapists in person. However, development of a marker-less motion analysis system with precise accuracy for joint identification, joint angle measurements and advanced motion analysis is an open challenge.

Objectives

The main objective of this paper is to provide a critical overview of recent computer vision-based marker-less human pose estimation systems and their applicability for rehabilitation application. An overview of some existing marker-less rehabilitation applications is also provided.

Methods

This paper presents a critical review of recent computer vision-based marker-less human pose estimation systems with focus on their provided joint localization accuracy in comparison to physiotherapy requirements and ease of use. The accuracy, in terms of the capability to measure the knee angle, is analysed using simulation.

Results

Current pose estimation systems use 2D, 3D, multiple and single view-based techniques. The most promising techniques from a physiotherapy point of view are 3D marker-less pose estimation based on a single view as these can perform advanced motion analysis of the human body while only requiring a single camera and a computing device. Preliminary simulations reveal that some proposed systems already provide a sufficient accuracy for 2D joint angle estimations.

Conclusions

Even though test results of different applications for some proposed techniques are promising, more rigour testing is required for validating their accuracy before they can be widely adopted in advanced rehabilitation applications.