Technology in Rehabilitation Seminar May 14 Online
FEScenter.org is hosting an online seminar entitled “Technology in Rehabilitation” on May 14. The event starts at 8:30am EDT (12:30pm in the UK, and between 8:30-10:30pm in Australia).
You can view the presentation Here.
Here’s a quick abstract of the speech:
Speaker:
Paolo Bonato Ph.D.
Assistant Professor, Department of Physical Medicine and Rehabilitation
Harvard Medical School
Title: “Technology in Rehabilitation”
Recent advances in sensing technology, robotics, and interactive gaming platforms have provided researchers and clinicians in the field of physical medicine and rehabilitation with new tools. These tools are aimed to improve the management of patients with impairments associated with the inability to perform certain activities of daily living such as walking on level ground, climbing a stairway, reaching for objects with the upper extremities, and manipulating small objects with the hands. Different clinical scenarios require the use of different technologies and the development of different systems and methodologies. In the older adults otherwise healthy, clinicians are interested in tracking activity profiles and detecting the worsening of motor function (e.g. balance control) so that adequate interventions can be set in place when needed. In individuals with severe mobility limitations such as those often associated with a stroke and traumatic brain injury, technology could be used to facilitate the recovery of motor functions. When individuals no longer respond in a clinically significant way to interventions, technology could be used to augment or replace function. This presentation aims at providing examples of clinical applications in which wearable sensors, robotics, and interactive gaming are relied upon in order to provide clinical personnel with ways to facilitate the recovery of motor function in patients with neurological conditions. Issues related to monitoring mobility in older adults and to detecting falls in the home environment will be presented in a clinical context and the technical characteristics of desirable systems for subjects’ monitoring will be discussed. Robotic systems designed for implementing exercise routines suitable to restore motor abilities in patients post stroke will be presented. The need for motivating patients using interactive gaming will be discussed together with the need for tracking the quality of the subject’s performance. This is a key point to guarantee that patients benefit from the exercise routines prescribed by clinicians. The need for tracking improvements in motor abilities in response to rehabilitation protocols will be emphasized. In conclusion, future scenarios depicting how we anticipate that technology will change physical medicine and rehabilitation in the next decade will be discussed.
– Source
Here’s a video from a February 2009 lecture by Kevin L. Kilgore about upper extremity devices for people with C5/C6 Spinal Cord Injuries. He focuses on the Freehand System, and implantable system for hand control:
And, finally, a link to all the lectures in the series.
Web-Based Hand, Arm, Shoulder Rehabilitation – Literature Review
A new study was published recently in the American Journal of Occupational Therapy detailing the results of a very small study involving a single post-stroke subject for one week of telerehabilitation. You can find more information here.
One may argue that such a study is anecdotal at best, and that a broader study is required to substantiate its claims.
Fortunately, there’s a long history of much more convincing scientific studies involving at-home rehabilitation of people with stroke and other neurological injuries like SCI. Such studies have generally shown positive results, which is why the results of the above study are not too surprising. I’ve provided links to abstracts and quick summaries of a few highlights below:
Efficacy of telemedicine in occupational therapy: a pilot study (2001) – The authors conclude that select occupational therapy evaluation data can be accurately transmitted and properly scored using low-bandwidth telemedicine systems.
Web-based telerehabilitation for the upper extremity after stroke (2002) – A description of a telerehabilitation system for stroke rehabilitation.
An Evaluation Framework for a Rural Home-Based Telerehabilitation Network (2005) – A survey of 43 professionals agreed that there are unmet needs among elderly people who are discharged from hospital settings.
Development of a teletechnology protocol for in-home rehabilitation (2006) – The authors’ results showed promise that both the telerehabilitation technology and intervention procedures were feasible in an elderly population.
A telerehabilitation approach to delivery of constraint-induced movement therapy (2006) – The authors reported large improvements in hand and arm function of post-stroke subjects. The gains were the same under both direct and remote supervision of a therapist.
Telerehabilitation using the Rutgers Master II glove following carpal tunnel release surgery: proof-of-concept (2007) – Dramatic improvements were achieved using the Rutgers Masters II haptic glove. All patients would either very strongly, or strongly recommend similar at-home therapy to others.
Telerehabilitation Using a Virtual Environment Improves Upper Extremity Function in Patients With Stroke (2007) -Home-based rehabilitation of 11 stroke subjects resulted in improvements of hand and arm function that were maintained at the time of a four month post-intervention evaluation.
Telerehabilitation is an exciting new field that holds the promise of providing cost-effective, high quality care to people facing a wide range of medical issues. For information about our telerehabilitation services, visit our stroke and SCI home rehabilitation page.
Stroke Rehabilitation with Robots
Researchers in the United States have found that robotic therapy can help stroke victims regain arm movement even years after their brain injuries. The study will be published in the online edition of the New England Journal of Medicine on Friday, April 23, 2010.
The study, a three-year randomized control trial (RCT) of 127 veterans in the U.S, found that stroke victims who had 12 weeks of robot-assisted therapy for their affected arm had an improved quality of life compared with those who had no additional therapy beyond the initial post-injury rehabilitation period. These findings go against conventional thinking that rehabilitation beyond the initial period had little benefit for stroke survivors.
Patients with moderate to severe disability in arm function resulting from stroke at least 6 months to five years earlier were included. After 6 months of therapy, the 49 patients in the robotic treatment group demonstrated clinically significant upper-arm function compared with the 28 patients who did not receive specific therapy for their upper limb.
Importantly, another 50 patients in the study did similar high-intensity exercises with the assistance of a therapist rather than a robot and demonstrated similar improvements.
Dr. Howard Kirshner, a professor and vice-chair in neurology at Vanderbilt Medical Center North in Nashville, commented to CBC:
“The most important take-away message for stroke survivors is that therapy, whether using new-fangled technologies, or using intensive standard therapy by trained therapists, is essential for optimal recovery of function after a stroke.”
CBC News
The study used the MIT Manus rehabilitation robot, developed at MIT, and commercialized by Interactive-Motion Technologies.
The findings are similar to those of another recent publication concerning the same device.
Here’s a video of the robot:
Glenrose Hospital – Virtual Reality Rehabiltation
Edmonton’s Glenrose Rehabilitation Hospital has acquired a new virtual reality system for rehabilitation. The CAREN (Computer-Assisted Rehabilitation Environment) will be installed over the next near, and will be ready for use in early 2011.
The product of Dutch company Motek Medical, CAREN consists of a large cylindrical screen and sophisticated projector system that creates a virtual environment. The user stands on a moving platform facing the screens that simulates motion in the virtual environment.
The Department of National Defence will cover $1.5 million of the $1.75 million price tag, with the Government of Alberta covering the additional $250,000.
Here’s a video of the CAREN in action:
Stroke Rehab Toronto
Researchers at the Toronto Rehabilitation Institute have joined forces with game designers at Algoma University in Sault Ste. Marie (700 km away, also in Ontario) to create video games to assist in speech therapy.
Dwayne Hammond, a strategic advisor at Algoma, suggests:
“All games teach, they’re all puzzles of some sort, and so if you develop a game specifically for rehabilitation purposes … it has potential to cause patients to follow their therapy much more than otherwise.”
When asked about the Nintendo Wii, and its use as a clinical modality for movement rehabilitation, Hammond says:
“The Wii is great but certainly I think the expectation is when you start to develop any product for an actual purpose, targeting something, you will be much more effective at that.”
The idea, which turned into the product the team is working on today, involves a therapist using paper cards to help patients exercise their brains. The cards contain illustrations of objects that patients must identify.
The team intends to move the identification program into software that can be used both in a clinical setting, as well as at home in a telerehabilitation capacity.
The team hopes to have created a commercially available product within a year.
Source: CTV, April 16, 2010
Stroke Rehabilitation in BC
The following table from a 2005 report from the BC Stroke Strategy shows patient wait times for post-stroke rehabilitation in British Columbia.
| Physiotherapy | Occupational Therapy | Speech Therapy | |
| Number of Locations Reporting Service | 57 (66%) | 41 (48%) | 21 (24%) |
| Range of wait time: In-Patient | 4 hours – 2 weeks | 24 hours – 7 days | 24 hours – 7 days |
| Range of wait time: Out-Patient | 2 days – 4 weeks | 7 days – 4 weeks | 1 week – indefinite |
This post will be updated with the latest numbers as soon as they are published.
Reporting hospitals’ level of knowledge regarding stroke programs offered as outpatient services or community services was limited in many cases. The most commonly reported hospital programs for stroke patients were general rehabilitation clinics and speech therapy. Community programs varied widely. Several sites reported support for patients and families offered by the Stroke Recovery Association. In fact, this is the most widely offered program of its type in Canada, with 38 groups located in: Cranbrook, Grand Forks, Kamloops, Kelowna, Prince George, Salmon Arm, Trail and District, Vanderhoof, Vernon, Burnaby, North Vancouver, Richmond, Vancouver, Abbotsford, Coquitlam, Langley, Maple Ridge / Pitt Meadows, Mission, Port Coquitlam, Powell River, Sechelt, South Delta, Surrey, White Rock, Alert Bay, Campbell River, Comox Valley, Nanaimo, Parksville, Saanich Peninsula, and Victoria.
Telehealth and TeleStroke News
Here’s a quick summary of telehealth news over the last four weeks.
1. CTN and AT&T Telehealth Network Expansion – The University of California’s California Telehealth Network (CTN) has a AT&T a contract to expand telehealth services in the state. Funding for the project comes for the FCC’s Rural Health Care Pilot Program. The project will see the CTN will working with AT&T to construct a statewide network connecting smaller regional hospitals and clinics to larger hospitals, giving rural residents access to more specialists and experts.
2. PricewaterhouseCoopers’s New HealthCast Report – According to a PricewaterhouseCoopers report, health care reform in the United States will results in a widespread effort to keep people well, out of the hospital and more engaged in managing their own health. The report suggests that lesser known provisions of the U.S. Health Reform package put increased emphasis on disease prevention, positive health outcomes and better coordination of care. Additionally, the report suggests the package emphasizes comparative effectiveness research, including more personalized medicine, which paves the way for more individualized care in a more patient-focused health system. According to the report, mass customization of health care services will be enabled by technology including smart phones, EMR databases, home health monitoring, telehealth, as well as wireless communication, social media and other Internet innovations.
3. Review of TeleStroke System in Kearney, Nebraska – The telestroke program in Nebraska uses a high-quality video and audio system to evaluate possible stroke patients in outlying hospitals. Typically, when patients suffer stroke, they have a limited time to receive clot-busting drugs, such as tPA. In this case, a physician only has three hours to make an intervention. Once a stroke patient is brought into an outlying hospital, the on-call neurologist in the system is available to evaluate the patient through telestroke.
ReJoyce at GF Strong in Vancouver
ReJoyce was recently on display at the GF Strong Rehabilitation Institute in Vancouver. Below are some pictures of Jennifer Loffree demonstrating ReJoyce to a crowd of Canadian Federal and Provincial politicians, including British Columbia’s Lieutenant Governor.
ReJoyce At GF Strong in Vancouver | Spinal Cord Injury Rehabilitation
ReJoyce is centerpiece of an ongoing spinal cord injury rehabilitation study in Vancouver. The study is investigating the rehabilitation efficacy of ReJoyce in combination with a hand stimulation system for people who have suffered a spinal cord injury. Subjects are treated at home, using our at-home rehabilitation software.
For information about ReJoyce, ongoing clinical trials, or anything else relating to home-based stroke and spinal cord injury rehabilitation, please contact us.
Headmouse
People with hand, arm and shoulder mobility issues use headmice to control computers. A typical headmouse combines a high resolution web camera and a reflective dot on a user’s forehead.
Here’s a link to a free headmouse tool that doesn’t require extra hardware (assuming you already have a webcam on your computer). I tested it out with my laptop’s built-in webcam. After making sure my face was adequately lit, it worked quite well for me.
It’s a little cumbersome to learn how to use initially. It’s actually quite useful, once you get the hang of it. The research group responsible for the software has created several other assistive software applications on their website for download.
Here’s a link to a site that sells the more expensive devices.