Telerehabilitation using Real Time Communication

There are many diseases affecting the population trends globally.Miniaturization of sensors in combined with medical information technology provides efficient solutions to reduce costs and deliver remote medical services through connected devices. Remote consultation via video‐conferencing has been well established, but the chronic or long‐term musculoskeletal conditions require pro‐active management and therapy thus raising the need to develop more advanced telerehabilitation systems. In this paper, we introduce KinectRTC that can be used for Kinect‐based telerehabilitationwith efficient real‐timetransmission of video, audio and skeletal data. The Web Real‐TimeCommunication (WebRTC) technology has benefitted to the proposed framework which is able to manage video and audio streams based on the state of the network and the available bandwidth to guarantee the real‐time performance of the communication

Measurements by A LEAP-Based Virtual Glove for the hand rehabilitation

Hand rehabilitation is fundamental after stroke or surgery. Traditional rehabilitation requires a therapist and implies high costs, stress for the patient, and subjective evaluation of the therapy effectiveness. Alternative approaches, based on mechanical and tracking-based gloves, can be really effective when used in virtual reality (VR) environments. Mechanical devices are often expensive, cumbersome, patient specific and hand specific, while tracking-based devices are not affected by these limitations but, especially if based on a single tracking sensor, could suffer from occlusions. In this paper, the implementation of a multi-sensors approach, the Virtual Glove (VG), based on the simultaneous use of two orthogonal LEAP motion controllers, is described. The VG is calibrated and static positioning measurements are compared with those collected with an accurate spatial positioning system. The positioning error is lower than 6 mm in a cylindrical region of interest of radius 10 cm and height 21 cm. Real-time hand tracking measurements are also performed, analysed and reported. Hand tracking measurements show that VG operated in real-time (60 fps), reduced occlusions, and managed two LEAP sensors correctly, without any temporal and spatial discontinuity when skipping from one sensor to the other. A video demonstrating the good performance of VG is also collected and presented in the Supplementary Materials. Results are promising but further work must be done to allow the calculation of the forces exerted by each finger when constrained by mechanical tools (e.g., peg-boards) and for reducing occlusions when grasping these tools. Although the VG is proposed for rehabilitation purposes, it could also be used for tele-operation of tools and robots, and for other VR applications

Telerehabilitation: State-of-the-Art from an Informatics Perspective

Rehabilitation service providers in rural or underserved areas are often challenged in meeting the needs of their complex patients due to limited resources in their geographical area. Recruitment and retention of the rural clinical workforce are beset by the ongoing problems associated with limited continuing education opportunities, professional isolation, and the challenges inherent to coordinating rural community healthcare. People with disabilities who live in rural communities also face challenges accessing healthcare. Traveling long distances to a specialty clinic for necessary expertise is troublesome due to inadequate or unavailable transportation, disability specific limitations, and financial limitations. Distance and lack of access are just two threats to quality of care that now being addressed by the use of videoconferencing, information exchange, and other telecommunication technologies that facilitate telerehabilitation. This white paper illustrates and summarizes clinical and vocational applications of telerehabilitation. We provide definitions related to the fields of telemedicine, telehealth, and telerehabilitation, and consider the impetus for telerehabilitation. We review the telerehabilitation literature for assistive technology applications, pressure ulcer prevention, virtual reality applications, speech-language pathology applications, seating and wheeled mobility applications, vocational rehabilitation applications, and cost-effectiveness. We then discuss external telerehabilitation influencers, such as the positions of professional organizations. Finally, we summarize clinical and policy issues in a limited context appropriate to the scope of this paper. Keywords: Telerehabilitation, Telehealth,Telemedicine, Telepractic

Telerehabilitation: State-of-the-Art from an Informatics Perspective

Abstract to follow --please check bac

Hand Rehabilitation and Telemonitoring through Smart Toys

We describe here a platform for autonomous hand rehabilitation and telemonitoring of young patients. A toy embedding the electronics required to sense fingers pressure in different grasping modalities is the core element of this platform. The system has been realized following the user-centered design methodology taking into account stakeholder needs from start: clinicians require reliable measurements and the ability to get a picture remotely on rehabilitation progression; children have asked to interact with a pleasant and comfortable object that is easy to use, safe, and rewarding. These requirements are not antithetic, and considering both since the design phase has allowed the realization of a platform reliable to clinicians and keen to be used by young children

Skuteczność terapii wśrodowisku wirtualnym wpierwszych 12 miesiącach po udarze mózgu

Background and purpose Reinforced feedback in virtual environment (RFVE) therapy is emerging as an innovative method in rehabilitation, which may be advantageous in the treatment of the affected arm after stroke. The purpose of this study was to investigate the impact of assisted motor training in a virtual environment for the treatment of the upper extremity (UE) after stroke compared to traditional neuromotor rehabilitation (TNR), studying also if differences exist related to the type of stroke (haemorrhagic or ischaemic). Material and methods Eighty patients affected by a stroke (48 ischaemic and 32 haemorrhagic) that occurred at least 1 year before were enrolled. The clinical assessment comprising the Fugl-Meyer UE (F-M UE), modified Ashworth (Bohannon & Smith) and Functional Independence Measure scale (FIM) was administered before and after the treatment. Results A statistically significant difference between RFVE and TNR groups (Mann-Whitney U-test) was observed in the clinical outcomes of F-M UE and FIM (both p < 0.001), but not Ashworth (p = 0.053). The outcomes of F-M UE and FIM improved in the RFVE haemorrhagic group and in the TNR haemorrhagic group with a significant difference between groups (both p < 0.001), but not for Ashworth (p = 0.651). Comparing the RFVE ischaemic group to the TNR ischaemic group, statistically significant differences emerged in F-M UE (p < 0.001), FIM (p < 0.001), and Ashworth (p = 0.036). Conclusions The RFVE therapy in combination with TNR showed better improvements compared to the TNR treatment only. The RFVE therapy combined with the TNR treatment was more effective than the TNR double training, in both post-ischaemic and post-haemorrhagic groups. We observed improvements in both groups of patients: post-haemorrhagic and post-ischaemic stroke after RFVE training.Wstęp i cel pracy Terapia w środowisku wirtualnym (reinforced feedback in virtual environment – RFVE) staje się nowatorską metodą w rehabilitacji, której zastosowanie może mieć korzystny wpływ w leczeniu porażonej kończyny górnej u chorych po udarze mózgu. Celem pracy było zbadanie wpływu terapii RFVE w leczeniu kończyny górnej po udarze mózgu w stosunku do tradycyjnej rehabilitacji neurologicznej (TRN) oraz określenie występowania różnic zależnych od rodzaju udaru mózgu (krwotoczny, niedokrwienny). Materiał i metody Badaniom poddano 80 chorych (48 pacjentów po udarze niedokrwiennym i 32 pacjentów po krwotocznym udarze mózgu) z niedowładem połowiczym w okresie do roku po przebytym udarze mózgu. Funkcje kończyny górnej oceniano na początku i po zakończeniu badania. Ocena kliniczna obejmowała skalę Fugl-Meyer dla kończyn górnych (F-M UE), zmodyfikowaną skalę Ashworth (Bohannon & Smith) i skalę Functional Independence Measure (FIM). Wyniki Zaobserwowano istotne różnice między grupami RFVE i TNR (test U Manna-Whitneya) w ocenie w skalach F-M UE i FIM (p < 0,001 dla obu różnic), nie stwierdzono natomiast różnicy w skali Ashworth (p = 0,053). Wyniki w skali F-M UE i FIM poprawiły się w grupie chorych z udarem krwotocznym po terapii RFVE i TNR z istotną różnicą pomiędzy grupami (p < 0,001 dla obu różnic), nie stwierdzono natomiast różnicy w skali Ashworth (p = 0,651). Istotne różnice odnotowano również, porównując grupę chorych z udarem niedokrwiennym po terapii RFVE oraz po terapii TNR w skalach F-M UE (p < 0,001), FIM (p = 0,001) i Ashworth (p = 0,036). Wnioski Zastosowanie RFVE połączonej z TNR prowadzi do większej poprawy niż leczenie wyłącznie za pomocą TNR. Terapia w środowisku wirtualnym połączona z TNR była skuteczniejsza niż TNR prowadzona dwa razy intensywniej niż zwykle, zarówno u chorych po udarze niedokrwiennym, jak i krwotocznym. Poprawa po RFVE dotyczyła nie tylko chorych po udarze niedokrwiennym, lecz także krwotocznym

Reinforced feedback in virtual environment for rehabilitation of upper extremity dysfunction after stroke: preliminary data from a randomized controlled trial.

OBJECTIVES: To study whether the reinforced feedback in virtual environment (RFVE) is more effective than traditional rehabilitation (TR) for the treatment of upper limb motor function after stroke, regardless of stroke etiology (i.e., ischemic, hemorrhagic). DESIGN: Randomized controlled trial. Participants. Forty-four patients affected by stroke. Intervention. The patients were randomized into two groups: RFVE (N = 23) and TR (N = 21), and stratified according to stroke etiology. The RFVE treatment consisted of multidirectional exercises providing augmented feedback provided by virtual reality, while in the TR treatment the same exercises were provided without augmented feedbacks. Outcome Measures. Fugl-Meyer upper extremity scale (F-M UE), Functional Independence Measure scale (FIM), and kinematics parameters (speed, time, and peak). RESULTS: The F-M UE (P = 0.030), FIM (P = 0.021), time (P = 0.008), and peak (P = 0.018), were significantly higher in the RFVE group after treatment, but not speed (P = 0.140). The patients affected by hemorrhagic stroke significantly improved FIM (P = 0.031), time (P = 0.011), and peak (P = 0.020) after treatment, whereas the patients affected by ischemic stroke improved significantly only speed (P = 0.005) when treated by RFVE. CONCLUSION: These results indicated that some poststroke patients may benefit from RFVE program for the recovery of upper limb motor function. This trial is registered with NCT01955291

The use of home-based digital technology to support post-stroke upper limb rehabilitation: A scoping review

Objective. To identify, map and synthesize the extent and nature of existing studies on the use of home-based digital technology to support post-stroke upper limb rehabilitation.Data sources. A comprehensive literature search was completed between 30 May 2022 and 05 April 2023, from seven online databases (CINAHL, Cochrane Library, PubMed, ScienceDirect, IEEExplore, Web of Science and PEDro), Google Scholar and the reference lists of already identified articles.Methods. A scoping review was conducted according to Arksey and O’Malley (2005), and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. All English-language studies reporting on the use of home-based digital technology to support upper limb post-stroke rehabilitation were eligible for inclusion.Results. The search generated a total of 1895 records, of which 76 articles met the inclusion criteria. Of these, 52 were experimental studies and the rest, qualitative, case series and case studies. Of the overall 2149 participants, 2028 were stroke survivors with upper limb impairment. The majority of studies were aimed at developing, designing and/or assessing the feasibility, acceptability and efficacy of a digital system for poststroke upper limb rehabilitation in home settings. The thematic analysis found six major categories: Tele-rehabilitation (n = 29), games (n = 45), virtual reality (n = 26), sensor (n = 22), mobile technology (n = 22), and robotics (n = 8).Conclusion. The digital technologies used in post-stroke upper limb rehabilitation were multimodal, and system-based comprising telerehabilitation, gamification, virtual reality, mobile technology, sensors and robotics. Furthermore, future research should focus to determine the effectiveness of these modalities

Computer Vision-Based Hand Tracking and 3D Reconstruction as a Human-Computer Input Modality with Clinical Application

The recent pandemic has impeded patients with hand injuries from connecting in person with their therapists. To address this challenge and improve hand telerehabilitation, we propose two computer vision-based technologies, photogrammetry and augmented reality as alternative and affordable solutions for visualization and remote monitoring of hand trauma without costly equipment. In this thesis, we extend the application of 3D rendering and virtual reality-based user interface to hand therapy. We compare the performance of four popular photogrammetry software in reconstructing a 3D model of a synthetic human hand from videos captured through a smartphone. The visual quality, reconstruction time and geometric accuracy of output model meshes are compared. Reality Capture produces the best result, with output mesh having the least error of 1mm and a total reconstruction time of 15 minutes. We developed an augmented reality app using MediaPipe algorithms that extract hand key points, finger joint coordinates and angles in real-time from hand images or live stream media. We conducted a study to investigate its input variability and validity as a reliable tool for remote assessment of finger range of motion. The intraclass correlation coefficient between DIGITS and in-person measurement obtained is 0.767- 0.81 for finger extension and 0.958–0.857 for finger flexion. Finally, we develop and surveyed the usability of a mobile application that collects patient data medical history, self-reported pain levels and hand 3D models and transfer them to therapists. These technologies can improve hand telerehabilitation, aid clinicians in monitoring hand conditions remotely and make decisions on appropriate therapy, medication, and hand orthoses

Preventing stillbirth from obstructed labor: A sensorized, low-cost device to train in safer operative birth

BACKGROUND: 98% of stillbirths occur in low- and middle- income countries. Obstructed labor is a common cause for both neonatal and maternal mortality, with a lack of skilled birth attendants one of the main reasons for the reduction in operative vaginal birth, especially in low- and middle- income countries. We introduce a low cost, sensorized, wearable device for digital vaginal examination to facilitate accurate assessment of fetal position and force applied to the fetal head, to aid training in safe operative vaginal birth. METHODS: The device consists of flexible pressure/force sensors mounted onto the fingertips of a surgical glove. Phantoms of the neonatal head were developed to replicate sutures. An Obstetrician tested the device on the phantoms by performing a mock vaginal examination at full dilatation. Data was recorded and signals interpreted. Software was developed so that the glove can be used with a simple smartphone app. A patient and public involvement panel was consulted on the glove design and functionality. RESULTS: The sensors achieved a 20 Newton force range and a 0.1 Newton sensitivity, leading to 100% accuracy in detecting fetal sutures, including when different degrees of molding or caput were present. They also detected sutures and force applied with a second sterile surgical glove on top. The software developed allowed a force threshold to be set, alerting the clinician when excessive force is applied. Patient and public involvement panels welcomed the device with great enthusiasm. Feedback indicated that women would accept, and prefer, clinicians to use the device if it could improve safety and reduce the number of vaginal examinations required. CONCLUSION: Under phantom conditions to simulate the fetal head in labor, the novel sensorized glove can accurately determine fetal sutures and provide real-time force readings, to support safer clinical training and practice in operative birth. The glove is low cost (approximately 1 USD). Software is being developed so fetal position and force readings can be displayed on a mobile phone. Although substantial steps in clinical translation are required, the glove has the potential to support efforts to reduce the number of stillbirths and maternal deaths secondary to obstructed labor in low- and -middle income countries