Development and evaluation of a haptic framework supporting telerehabilitation robotics and group interaction

Telerehabilitation robotics has grown remarkably in the past few years. It can provide intensive training to people with special needs remotely while facilitating therapists to observe the whole process. Telerehabilitation robotics is a promising solution supporting routine care which can help to transform face-to-face and one-on-one treatment sessions that require not only intensive human resource but are also restricted to some specialised care centres to treatments that are technology-based (less human involvement) and easy to access remotely from anywhere. However, there are some limitations such as network latency, jitter, and delay of the internet that can affect negatively user experience and quality of the treatment session. Moreover, the lack of social interaction since all treatments are performed over the internet can reduce motivation of the patients. As a result, these limitations are making it very difficult to deliver an efficient recovery plan. This thesis developed and evaluated a new framework designed to facilitate telerehabilitation robotics. The framework integrates multiple cutting-edge technologies to generate playful activities that involve group interaction with binaural audio, visual, and haptic feedback with robot interaction in a variety of environments. The research questions asked were: 1) Can activity mediated by technology motivate and influence the behaviour of users, so that they engage in the activity and sustain a good level of motivation? 2) Will working as a group enhance users’ motivation and interaction? 3) Can we transfer real life activity involving group interaction to virtual domain and deliver it reliably via the internet? There were three goals in this work: first was to compare people’s behaviours and motivations while doing the task in a group and on their own; second was to determine whether group interaction in virtual and reala environments was different from each other in terms of performance, engagement and strategy to complete the task; finally was to test out the effectiveness of the framework based on the benchmarks generated from socially assistive robotics literature. Three studies have been conducted to achieve the first goal, two with healthy participants and one with seven autistic children. The first study observed how people react in a challenging group task while the other two studies compared group and individual interactions. The results obtained from these studies showed that the group interactions were more enjoyable than individual interactions and most likely had more positive effects in terms of user behaviours. This suggests that the group interaction approach has the potential to motivate individuals to make more movements and be more active and could be applied in the future for more serious therapy. Another study has been conducted to measure group interaction’s performance in virtual and real environments and pointed out which aspect influences users’ strategy for dealing with the task. The results from this study helped to form a better understanding to predict a user’s behaviour in a collaborative task. A simulation has been run to compare the results generated from the predictor and the real data. It has shown that, with an appropriate training method, the predictor can perform very well. This thesis has demonstrated the feasibility of group interaction via the internet using robotic technology which could be beneficial for people who require social interaction (e.g. stroke patients and autistic children) in their treatments without regular visits to the clinical centres

Development and implementation of technologies for physical telerehabilitation in Latin America:

La telerehabilitation ha surgido debido a la inclusión de tecnologías emergentes para la captura, transmisión, análisis y visualización de patrones de movimiento asociados a pacientes con trastornos músculo-esqueléticos. Esta estrategia permite llevar a cabo procesos de diagnóstico y tratamientos de rehabilitación a distancia. Este artículo presenta una revisión sistemática del desarrollo e implementación actual de las tecnologías de telerehabilitación en la región latinoamericana. El objetivo principal es explorar, a partir de la literatura científica reportada y fuentes divulgativas, si las tecnologías de telerehabilitación han logrado ser introducidas en esta región. Asimismo, este trabajo revela los prototipos actuales o sistemas que están en desarrollo o que ya están siendo usados. Se llevó a cabo una revisión sistemática, mediante dos búsquedas diferentes. La primera implicó una búsqueda bibliográfica rigurosa en los repositorios digitales científicos más relevantes en el área y la segunda incluyó proyectos y programas de telerehabilitación implementados en la región, encontrados a partir de una búsqueda avanzada en Google. Se encontró un total de 53 documentos de seis países (Colombia, Brasil, México, Ecuador, Chile y Argentina); la mayoría de ellos estaban enfocados en iniciativas académicas y de investigación para el desarrollo de prototipos tecnológicos para telerehabilitación de pacientes pediátricos y adultos mayores, afectados por deficiencias motoras o funcionales, parálisis cerebral, enfermedades neurocognitivas y accidente cerebrovascular. El análisis de estos documentos reveló la necesidad de un extenso enfoque integrado de salud y sistema social para aumentar la disponibilidad actual de iniciativas de telerehabilitación en la región latinoamericana.Telerehabilitation has arised by the inclusion of emerging technologies for capturing, transmitting, analyzing and visualizing movement patterns associated to musculoskeletal disorders. This therapeutic strategy enables to carry out diagnosis processes and provide rehabilitation treatments. This paper presents a systematic review of the current development and implementation of telerehabilitation technologies in Latin America. The main goal is to explore the scientific literature and dissemination sources to establish if such technologies have been introduced in this region. Likewise, this work highlights existing prototypes or systems that are to being used or that are still under development. A systematic search strategy was conducted by two different searches: the first one involves a rigorous literature search from the most relevant scientific digital repositories; the second one included telerehabilitation projects and programs retrieved by an advanced Google search. A total of 53 documents from six countries (Colombia, Brazil, Mexico, Ecuador, Chile and Argentina) were found. Most of them were focused on academic and research initiatives to develop in-home telerehabilitation technologies for pediatric and elderly populations affected by motor and functional impairment, cerebral palsy, neurocognitive disorders and stroke. The analysis of the findings revealed the need for a comprehensive approach that integrates health care and the social system to increase the current availability of telerehabilitation initiatives in Latin America

INTENTIONS TO USE TELEREHABILITATION FOR COMMUNICATION AND TREATMENT FOR VISION IMPAIRMENTS

BACKGROUND: Approximately 8.1 million people in the United States 18 and older have difficulty performing one or more daily activities because of vision impairment or blindness (Erickson, Lee, & von Schrader, 2020; Taylor, 2018). If the impairments caused by vision loss are not addressed, they can result in financial difficulties, suffering, disability, loss of productivity, and decreased quality of life (National Center for Chronic Disease Prevention and Health Promotion, 2011). Currently, in-person low vision rehabilitation services are the gold standard for teaching people how to adapt to and compensate for these deficits, however, the access and utilization of these services by people with vision impairments is poor. Telerehabilitation is one service delivery option that has been used in other settings to increase access and utilization of low vision services. This study investigated the underlying factors that are related to three stakeholder groups’ behavioral intention to use telerehabilitation as a low vision rehabilitation service delivery option. METHODS: This pilot study utilized an anonymous pre-validated online survey to collect data from people with vision impairments, eye care professionals, and vision rehabilitation professionals. Participants were recruited by email or through social media. RESULTS: Fifty-two people participated in the survey – 12 males (23%) and 40 females (77%). Participants’ ages ranged from 21 to 79 years of age (M = 45.2, SD = 12.6). Twenty-two people with vision impairments (42%) participated in the survey, followed by 21 (40%) vision rehabilitation professionals, and nine (17%) eye care professionals. Most of the participants reported feeling very comfortable with using computers (85%), mobile devices (85%), and videoconferencing software (64%). More than half of the sample reported being very skilled using computers (70%), mobile devices (76%), and videoconferencing programs (59%). All participants, except for one, reported using a computer for at least 1 year. Twenty-one participants – 3 people with vision impairments, 3 eye care professionals, and 15 vision rehabilitation professionals - reported having used telerehabilitation. Twenty participants (43%) reported having the behavioral intention to use telerehabilitation in the future while 17 participants (36%) stated that they planned on using telerehabilitation in their daily lives. For this study’s adapted and extended UTAUT model, small effect size relationships were noted between behavioral intention and performance expectancy (r = .295), and behavioral intention and resistance to change (r = .254). Age, gender, and experience were not found to be confounding variables between the predictor variables and behavioral intention. The people with vision impairment group was noted to have small effect sizes for the relationships between behavioral intention and performance expectancy (r = .218), and effort expectancy (r = .271), and technology anxiety (r = -.321). Age, gender, or experience were not found to act as confounding variables in these relationships. Eye care professionals had a moderate effect size for the relationship between behavioral intention and performance expectancy (r = .414) which appeared to be confounded by gender (r = .830) and experience (r = .671). They also had a small effect size relationship between behavioral intention and technology anxiety (r = .213) which appeared to be confounded by experience (r = .515). Gender and experience were also noted to be confounding variables for the relationship between behavioral intention and resistance to change. Age, gender, or experience were not found to act as confounding variables in these relationships. For the vision rehabilitation group, there was only one small effect size found for the relationship between behavioral intention and resistance to change (r = .243) which was noted to be confounded by experience (r = .463). CONCLUSIONS: The use of telerehabilitation as a low vision service delivery option is still a new area of inquiry. This study was the first to explore the underlying factors of three stakeholder groups’ behavioral intention to use telerehabilitation as a service delivery option. Most of the participants with vision impairments reported not having difficulty accessing traditional in-person low vision rehabilitation services, or not planning on using telerehabilitation services in the future. These findings were contrary to assertions made by previous literature (Lam and Leat, 2013; Hoque and Sorwar, 2017). Eye care professionals also reported being very comfortable and skilled with various technologies, but were more open to change and accepting of new technologies, like telerehabilitation. Therefore, eye care professionals’ behavioral intention to use telerehabilitation in the future was higher than the other two groups. The vision rehabilitation group was similar to the eye care professional group in the behavioral intention to use telerehabilitation, and similar to the people with vision impairments group in their high level of resistance to change. Like the people with vision impairments group, the vision rehabilitation professional group appeared to be satisfied with the in-person low vision rehabilitation services that are already being delivered, and may not recognize the need for another service delivery option at this time. This study provides preliminary information that can be used in future studies that seek to understand why different stakeholder groups choose to accept and plan to use telerehabilitation. Once this information is better understood, researchers can build upon this information to increase the actual use of telerehabilitation among all three stakeholder groups. Limitations of this study that impact the interpretation of this study’s results and generalizability to a broader population are poor response rates, single survey response method, stringent inclusion criteria, and accessibility issues. Recommendations for future studies consist of addressing the study’s limitations as well as the intrinsic and extrinsic factors of each stakeholder group’s behavioral intention to use telerehabilitation. Overall, this study adds to the body of knowledge in the areas of telerehabilitation and low vision rehabilitation

AI enhanced collaborative human-machine interactions for home-based telerehabilitation

The use of robots in a telerehabilitation paradigm could facilitate the delivery of rehabilitation on demand while reducing transportation time and cost. As a result, it helps to motivate patients to exercise frequently in a more comfortable home environment. However, for such a paradigm to work, it is essential that the robustness of the system is not compromised due to network latency, jitter, and delay of the internet. This paper proposes a solution to data loss compensation to maintain the quality of the interaction between the user and the system. Data collected from a well-defined collaborative task using a virtual reality (VR) environment was used to train a robotic system to adapt to the users' behaviour. The proposed approach uses nonlinear autoregressive models with exogenous input (NARX) and long-short term memory (LSTM) neural networks to smooth out the interaction between the user and the predicted movements generated from the system. LSTM neural networks are shown to learn to act like an actual human. The results from this paper have shown that, with an appropriate training method, the artificial predictor can perform very well by allowing the predictor to complete the task within 25 s versus 23 s when executed by the human

The future of rehabilitation in the United Kingdom National Health Service: Using the COVID-19 crisis to promote change, increasing efficiency and effectiveness

The problem: Rehabilitation services in the UK are inadequate, with insufficient capacity or flexibility to meet the needs of patients after Covid-19. History: Rehabilitation developed in a piecemeal way, focused on specific problems: spinal cord injury, burns, polio, stroke, back pain, equipment and adaptations etc. Rehabilitation is also provided using other names (e.g. intermediate care). Patients with complex needs do not fit easily within this system. System failure: After Covid-19, patients have problems that cross existing condition-specific and/or treatment-specific services. Covid-19 has exposed the lack of any coherent organisational principle underlying development or commissioning of rehabilitation services. Consequently, in order to have their needs met, patients either have to engage with two or more separate services or they receive good management for some problems and sub-optimal management for other problems. The goals: The multitude of small specific services need to coalesce into an integrated service able to meet all the needs of any patient referred. Second, rehabilitation needs to be fully integrated into all healthcare services. A solution: The purpose of healthcare is to ‘improve our health and well-being . . . to stay as well as we can to the end of our lives’. (NHS constitution) All healthcare services need to consider patients holistically, giving equal attention to disease, disability, and distress. Rehabilitation, acute care, mental health and palliative care services need to work in parallel to achieve this purpose. Healthcare providers, supported by commissioners and rehabilitation experts, could achieve structural and organisational change, meeting the needs of patients

An instrumental approach for monitoring physical exercises in a visual markerless scenario: A proof of concept

none8This work proposes a real-time monitoring tool aimed to support clinicians for remote assessing exercise performances during home-based rehabilitation. The study relies on clinician indications to define kinematic features, that describe five motor tasks (i.e., the lateral tilt of the trunk, lifting of the arms, trunk rotation, pelvis rotation, squatting) usually adopted in the rehabilitation program for axial disorders. These features are extracted by the Kinect v2 skeleton tracking system and elaborated to return disaggregated scores, representing a measure of subjects performance. A bell-shaped function is used to rank the patient performances and to provide the scores. The proposed rehabilitation tool has been tested on 28 healthy subjects and on 29 patients suffering from different neurological and orthopedic diseases. The reliability of the study has been performed through a cross-sectional controlled design methodology, comparing algorithm scores with respect to blinded judgment provided by clinicians through filling a specific questionnaire. The use of task-specific features and the comparison between the clinical evaluation and the score provided by the instrumental approach constitute the novelty of the study. The proposed methodology is reliable for measuring subject's performance and able to discriminate between the pathological and healthy condition.Capecci, Marianna; Ceravolo, Maria Gabriella; Ferracuti, Francesco; Grugnetti, Martina; Iarlori, Sabrina; Longhi, Sauro; Romeo, Luca; Verdini, FedericaCapecci, Marianna; Ceravolo, Maria Gabriella; Ferracuti, Francesco; Grugnetti, Martina; Iarlori, Sabrina; Longhi, Sauro; Romeo, Luca; Verdini, Federic

Optimising rehabilitation and recovery after a stroke

Stroke can cause significant disability and impact quality of life. Multidisciplinary neurorehabilitation that meets individual needs can help to optimise recovery. Rehabilitation is essential for best quality care but should start early, be ongoing and involve effective teamwork. We describe current stroke rehabilitation processes, from the hyperacute setting through to inpatient and community rehabilitation, to long-term care and report on which UK quality care standards are (or are not) being met. We also examine the gap between what stroke rehabilitation is recommended and what is being delivered, and suggest areas for further improvement