April 22, 2010
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.
April 20, 2010
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:
March 30, 2010
Improved Hand Function in Cerebral Palsy
A Rutgers-based study, recently published in the IEEE Transactions on Information Technology in Biomedicine journal, has shown that an at-home treatment regimen involving video games can improve hand function in teenagers with cerebral palsy.
The pilot study, involving only three teenage participants, combined a Sony Playstation 3 console and a commercial gaming glove with their custom-made games. Rutgers engineers created custom game and exercise software aimed at improving hand speed and range of motion.
The system enhanced the participants’ abilities to perform a range of daily personal and household activities.
After three months of therapy, two study participants were able to lift heavy objects, a task they were unable to accomplish before the trial. Participants showed varying improvement in activities of daily living including brushing teeth, shampooing, dressing and opening heavy doors.
The study was the result of a collaboration between engineers at Rutgers University’s Tele-Rehabilitation Institute and clinicians at the Indiana University School of Medicine.
In addition to game and exercise software, the apparatus features an online telerehabilitation platform that allowed researchers to oversee participants’ routines and evaluate their recovery of motor function.
Here’s a link to the full article (requires a subscription to the journal).
Here’s a video from the Rutgers website:
March 18, 2010
Robot Stroke Rehabilitation Results in “Modest Improvements”
A recent randomized trial of 127 stroke survivors has shown no significant difference between rehabilitation with the assistance of a robotic workstation and more conventional rehabilitation with the assistance of a human.
The study, conducted by Dr. Albert Lo of the Providence VA Medical Center in Rhode Island, separated 127 participants into three groups: human-assisted rehabilitation (50 patients), robot-assisted rehabilitation (49 patients), and usual care consisting of treatment with antiplatelets, antihypertensives and recommendations for diet and exercise (28 patients).
Dr. Lo described improvements in both the robot-assisted and human-assisted as “fairly modest.” He went on to say that the improvements were important “because there’s very little available for people with chronic stroke.”
The study focused on rehabilitation of the upper extremity, involving repetitive rehabilitation exercises in stroke patients with moderate-to-severe arm disability. The rehabilitation programs lasted 12 weeks, three one-hour sessions per week, and involved the same number of repetitions of arm exercises.
Outcome evaluations were performed immediately after the 12 week rehabilitation program, and included the Fugl-Meyer Assessment of basic motor function (the primary endpoint), the Wolf Motor Function Test of time to complete everyday tasks, and the Stroke Impact Scale. No significant differences were found between the human-assisted and robot-assisted treatment groups.
At the end of the follow-up period (36 weeks), patients who received robot or human-assisted rehabilitation had slightly better scores on all outcome measures than those in the usual care.
There were no differences between robot-assisted and human-assisted rehab on any of the outcomes at any time point.
The cost difference in treatment was substantial: the initial cost of the robots was $200,000, and the cost of the robot-assisted rehab program was around $1200 more per patient than that of usual care over the course of the year.
From this article, I gather that the robots were made by Interactive Motion Technologies.
October 16, 2009
Modified Constraint Induced Movement Therapy Discussion
In early 2008, an online discussion took place between two researchers regarding the implementation details of Constraint Induced Movement Therapy (CIMT). Dr. Steven Wolf, the principle investigator of the 2006 EXCITE study makes some interesting comments about Dr. Steven Page’s mCIT trial (Modified Constraint Induced Therapy).The following compares a few of the main components of Dr. Wolf’s CIMT and Dr. Page’s mCIT:
| CIMT | mCIT | |
| Location | clinic | home |
| Hours of Daily Therapy | 6 hours* | 0.5 hours |
| Duration of Therapy | 3-6 weeks | 10 weeks |
| Daily Arm Restraint** | 9 hours/day for 2 weeks | 5 hours/day for 5 days/week for 10 weeks |
| Benefit to Patient | Statistically Significant: refer to article |
Statistically Significant: refer to article |
* patients experiencing fatigue are not be required to complete 6 hours/day
** CIMT and mCIT require that patients restrain their less affected limb for periods of time during the day.
June 2, 2009
Arkansas Telerehab and Medicaid Reimbursement
Here’s a great video story from last year about a telerehabilitation program going on in Little Rock Arkansas. This hospital has implemented a simple two-way video chat into a patient’s home. Here are the highlights:
- patient suffered a broken hip as the result of a fall
- audio/video link from a hospital into a patient’s home
- both physical and occupational therapists are interacting with the patient over the link
- the patient is very happy with the service
- the clinic administrators see tremendous potential for at-home rehab to be far more convenient for patients and financially competitive for hospitals
- other devices can be hooked up to the computer to be used with a telerehab system (our ReJoyce Telerehabilitation System is a great example)
Arkansas is one of a number states that leaves decisions regarding reimbursement of telemedicine programs, including telerehabilitation, up to the state Medicaid director. Take a look at this 2004 study regarding Medicaid telerehabilitation reimbursement throughout the United States.
May 15, 2009
Telemedicine and Stroke Care
Here’s the latest from the American Heart Association.
A Review of the Evidence for the Use of Telemedicine Within Stroke Systems of Care
- Few patients receive treatment benefit with evidence-based and FDA-approved tissue plasminogen activator, partly due to lack of access to this treatment.
- Stroke Telemedicine (Telestroke, Teleconsultation) provides an opportunity to increase access to specialist expertise (neurological) in areas where disparities exist for stroke care (urban and rural).
- Telemedicine is an important care modality in the stroke systems of care model.
Recommendations for the Implementation of Telemedicine Within Stroke Systems of Care
- Telemedicine technology provides specialists with the data necessary to assist clinicians at the bedside in stroke-related decision making for patients presenting at distant or under-equipped facilities.
- The reported numbers of telestroke consultations overall and those that lead to thrombolysis show that the use of telemedicine is feasible and has already impacted local stroke care.
- Barriers to effective telestroke implementation include licensure and liability laws, technology assessment and deployment, community outreach/education, assuring confidentiality of information shared, and processes of requesting and delivering telemedicine consultations.
May 1, 2009
New Hampshire Senate passes Telecare Bill
The N.H Senate has passed a bill requiring insurance companies to reimburse certain medical appointments whether they happen face-to-face or not.
“…This is vastly going to reduce the costs of health care and help with early detection,” said Sen. Debbie Reynolds, D-Plymouth. Telemedicine would help with early detection and “access to specialty care that would reduce the severity of diseases…”
Read the full article here.
Proposal for More Telemedicine Coverage
California Congressman Mike Thompson has introduced legislation to screen returning soldiers for PTSD and to expand access to telemedicine. This bill is a companion to one introduced in the Senate by Montana Senator Max Baucus. Here’s an excerpt from the article:
“…The telemedicine legislation would provide $30 million in grants to help health facilities pay for telehealth equipment and expand telehealth support services… The Medicare Telehealth Enhancement Act would expand Medicare reimbursement to urban and suburban areas and include more families…”
You can read the rest of the article here.
