Uma arquitetura de telerreabilitação baseada em realidade aumentada para apoiar o treinamento de usuários de cadeiras de rodas motorizadas

Many people worldwide have been experimenting a decrease in their mobility as a result of aging, accidents and degenerative diseases. In many cases, a Powered Wheelchair (PW) is an alternative help. Currently, in Brazil, patients can receive a PW from the Unified Health System, following prescription criteria. However, they do not have an appropriate previous training for driving the PW. Consequently, users might suffer accidents since a customized training protocol is not available. Nevertheless, due to financial and/or health limitations, many users are unable to attend a rehabilitation center. To overcome these limitations, we developed an Augmented Reality (AR) Telerehabilitation System Architecture based on the Power Mobility Road Test (PMRT), for supporting PW user’s training. In this system, the therapists can remotely customize and evaluate training tasks and the user can perform the training in safer conditions. Video stream and data transfer between each environment were made possible through UDP (User Datagram Protocol). To evaluate and present the system architecture potential, a preliminary test was conducted with 3 spinal cord injury participants. They performed 3 basic training protocols defined by a therapist. The following metrics were adopted for evaluation: number of control commands; elapsed time; number of collisions; biosignals and a questionary was used to evaluate system features by participants. Results demonstrate the specific needs of individuals using a PW, thanks to adopted (qualitative and emotional) metrics. Also, the results have shown the potential of the training system with customizable protocols to fulfill these needs. User’s evaluation demonstrates that the combination of AR techniques with PMRT adaptations, increases user’s well-being after training sessions. Furthermore, a training experience helps users to overcome their displacement problems, as well as for appointing challenges before large scale use. The proposed system architecture allows further studies on telerehabilitation of PW users.CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorTese (Doutorado)Muitas pessoas em todo o mundo estão vivenciando uma diminuição de sua mobili- dade como resultado de envelhecimento, acidentes e doenças degenerativas. Em muitos casos, uma cadeira de rodas motorizada (CRM) é uma ajuda alternativa. Atualmente, no Brasil, os pacientes podem receber uma CRM do Sistema Único de Saúde, seguindo os critérios de prescrição. No entanto, eles não têm um treinamento prévio apropriado para dirigir a CRM. Conseqüentemente, os usuários podem sofrer acidentes, pois um protocolo de treinamento personalizado não está disponível. Além disto, devido a limi- tações financeiras e / ou de saúde, muitos usuários não podem comparecer a um centro de reabilitação. Para superar essas limitações, desenvolvemos uma arquitetura de sistema de telereabilitação com Realidade Aumentada (RA) baseado no PMRT (Power Mobility Road Test), para apoiar o treinamento de usuários de CRM. Nesse sistema, os terapeutas podem personalizar e avaliar remotamente as tarefas de treinamento e o usuário pode realizar o treinamento em condições mais seguras. O fluxo de vídeo e a transferência de dados entre cada ambiente foram possíveis através do UDP (User Datagram Protocol). Para avaliar e apresentar o potencial da arquitetura do sistema, foi realizado um teste preliminar de três participantes com lesão medular. Eles realizaram três protocolos básicos de treinamento definidos por um terapeuta. As seguintes métricas adotadas para avaliação foram: número de comandos de controle; tempo decorrido; número de colisões e biossinais. Além disso, um questionário foi usado para avaliar os recursos do sistema. Os resultados demonstram as necessidades específicas dos indivíduos que usam uma CRM, graças às métricas adotadas (qualitativas e emocionais). Além disso, os resultados mostraram o potencial do sistema de treinamento com protocolos personalizáveis para atender a essas necessidades. A avaliação do usuário demonstra que a combinação de técnicas de RA com adaptações PMRT aumenta o bem-estar do usuário após as sessões de treinamento. Além disso, esta experiência de treinamento ajuda os usuários a superar seus problemas de deslocamento, bem como a apontar desafios antes do uso em larga escala. A arquitetura de sistema proposta, permite estudos adicionais sobre a telerreabilitação de usuários de CRM

Developing effective strategies to optimize physical activity and cardiorespiratory fitness in the long Covid population- The need for caution and objective assessment

he Post Covid-19 Condition (commonly known as Long Covid) has been defined by the World Health Organisation as occurring in individuals with a history of probable or confirmed SARS CoV 2 infection, usually within 3 months from the onset of acute Covid-19 infection with symptoms that last for at least two months which cannot be explained by an alternative diagnosis. Long Covid is associated with over two hundred recognised symptoms and affects tens of millions of people worldwide. Widely reported reductions in quality of life(QoL) and functional status are caused by extremely sensitive and cyclical symptom profiles that are augmented following exposure to physical, emotional, orthostatic, and cognitive stimuli. This manifestation prevents millions of people from engaging in routine activities of daily living (ADLs) and has important health and well-being, social and economic impacts. Post-exertional symptom exacerbation (PESE) (also known as post-exertional malaise) is an exacerbation in the severity of fatigue and other symptoms following physical, emotional, orthostatic and cognitive tasks. Typically, this will occur 24–72 h after “over-exertion” and can persist for several days and even weeks. It is a hallmark symptom of Long Covid with a reported prevalence of 86%. The debilitating nature of PESE prevents patients from engaging in physical activity which impacts functional status and QoL. In this review, the authors present an update to the literature relating to PESE in Long Covid and make the case for evidence-based guidelines that support the design and implementation of safe rehabilitation approaches for people with Long Covid. This review also considers the role of objective monitoring to quantify a patient's response to external stimuli which can be used to support the safe management of Long Covid and inform decisions relating to engagement with any stimuli that could prompt an exacerbation of symptoms

a critical review

The availability of wearable devices (WDs) to collect biometric information and their use during activities of daily living is significantly increasing in the general population. These small electronic devices, which record fitness and health-related outcomes, have been broadly utilized in industries such as medicine, healthcare, and fitness. Since they are simple to use and progressively cheaper, they have also been used for numerous research purposes. However, despite their increasing popularity, most of these WDs do not accurately measure the proclaimed outcomes. In fact, research is equivocal about whether they are valid and reliable methods to specifically evaluate physical activity and health-related outcomes in older adults, since they are mostly designed and produced considering younger subjects? physical and mental characteristics. Additionally, their constant evolution through continuous upgrades and redesigned versions, suggests the need for constant up-to-date reviews and research. Accordingly, this article aims to scrutinize the state-of-the-art scientific evidence about the usefulness of WDs, specifically on older adults, to monitor physical activity and health-related outcomes. This critical review not only aims to inform older consumers but also aid researchers in study design when selecting physical activity and healthcare monitoring devices for elderly people.DB19-D819-F720 | Carlos Eduardo da Silva TeixeiraN/

A Sensing Platform to Monitor Sleep Efficiency

Sleep plays a fundamental role in the human life. Sleep research is mainly focused on the understanding of the sleep patterns, stages and duration. An accurate sleep monitoring can detect early signs of sleep deprivation and insomnia consequentially implementing mechanisms for preventing and overcoming these problems. Recently, sleep monitoring has been achieved using wearable technologies, able to analyse also the body movements, but old people can encounter some difficulties in using and maintaining these devices. In this paper, we propose an unobtrusive sensing platform able to analyze body movements, infer sleep duration and awakenings occurred along the night, and evaluating the sleep efficiency index. To prove the feasibility of the suggested method we did a pilot trial in which several healthy users have been involved. The sensors were installed within the bed and, on each day, each user was administered with the Groningen Sleep Quality Scale questionnaire to evaluate the user’s perceived sleep quality. Finally, we show potential correlation between a perceived evaluation with an objective index as the sleep efficiency.</p

Mobile Health Technologies

Mobile Health Technologies, also known as mHealth technologies, have emerged, amongst healthcare providers, as the ultimate Technologies-of-Choice for the 21st century in delivering not only transformative change in healthcare delivery, but also critical health information to different communities of practice in integrated healthcare information systems. mHealth technologies nurture seamless platforms and pragmatic tools for managing pertinent health information across the continuum of different healthcare providers. mHealth technologies commonly utilize mobile medical devices, monitoring and wireless devices, and/or telemedicine in healthcare delivery and health research. Today, mHealth technologies provide opportunities to record and monitor conditions of patients with chronic diseases such as asthma, Chronic Obstructive Pulmonary Diseases (COPD) and diabetes mellitus. The intent of this book is to enlighten readers about the theories and applications of mHealth technologies in the healthcare domain

Feasibility and Initial Efficacy of Home-Based Cardiac Telerehabilitation— A Pilot Study

Background: Cardiovascular Disease (CVD) is the top health problem all over the world, including China. Home-based rehabilitation after cardiac surgery has been shown to be beneficial. In our study, a clinical study has been carried out to investigate the feasibility and effectiveness of using emergent mobile and information technology to deliver monitoring and feedback function in Home-Based Cardiac Telerehabilitation program (HBCTR). The main purpose of this study is to assess the feasibility and acceptance of the HBCTR program in low risk patients post Percutaneous Coronary Intervention (PCI). The secondary purpose is to assess the initial efficacy of the HBCTR program. Method: A single-blinded parallel two-arm Randomized Controlled Trial (RCT) has been conducted at the First Affiliated Hospital of Shantou University Medical College, China. A total of 24 post PCI patients were recruited and randomly divided into two equal groups. The control group (Usual Care (UC) program) received paper-based CVD educational booklets and biweekly outpatient review. The experiment group (HBCTR program) carried out outdoor walking/jogging exercise with real time physiological monitoring along with CVD education materials. Feasibility and acceptance of the HBCTR program were evaluated by using an acceptance questionnaire, a satisfaction questionnaire, patients’ adherence evaluation, system abnormalities analysis, and safety evaluation. The effectiveness of this program was measured by using 6 Minutes Walking Test (6MWT), Fagerstrom Test for Nicotine Dependence (FTND), Cardiac Depression Scale (CDS)), and SF-36 Health Survey. Results: A total of 53 respondents completed the HBCTR patient acceptance questionnaire, and 22 participants completed the RCT. One experiment group participant withdrew, and one control group participant lost contact during the RCT. 67.9% of participants deemed the HBCTR program acceptable due to real time exercise monitoring and emergency alert function. Features including real time exercise monitoring and emergency alerts are attributed to the high acceptance of the HBCTR program. The HBCTR program is perceived to allow patients to exercise in a safer and more independent manner compared to the UC method, and 81.8% of participants (n=9) felt satisfied with the HBCTR program. The average adherence rates of HBCTR in terms of exercise trainings, self-reporting, and medication intake are 92.9%, 88.4%, and 90.0% respectively. No serious adverse event was reported in the study; Out of the 184 exercise trainings the HBCTR remote monitoring system had only 7(3.8%) temporary system failures. After the six- week intervention, both groups resulted in statistically significant improvements in SF-36 physical component summary (PCS), SF-36 mental component summary (MCS), 6MWT, FTND, DASI, and CDS. Furthermore, patients in the experimental group had better improvements compared to patients in the control group in PCS scores in SF-36 (HBCTR: Δ12.5±7.8 vs UC: Δ 4.6±5.7), DASI (HBCTR: Δ0.7±0.5 vs UC: Δ 0.3±0.4), and 6 MWT (HBCTR: Δ45.5±17.4 vs UC: Δ27.6±14.7). Conclusion: The proposed HBCTR program is feasible and safe for low-risk post PCI patients. Although improvements were observed in both groups, the physical indicators of PCS and 6MWT of HBCTR patients exceeded those of the UC patients. The patients in the HBCTR program showed high satisfaction and decreased fears in performing rehabilitation exercise “at home” with remote monitoring. With this decreased fears in exercise, the adherence among the HBCTR patients was high which resulted in their benefit physical outcomes. Future study with multiple centers and a large-scale randomized controlled trial can be carried out to further assess the efficiency of the HBCTR program in long term. Cost analysis also can be added into the further study to compare the cost effective between HBCTR and traditional center-based CR

PHYSIOLOGICAL PREDICTORS OF BEHAVIORAL DYSREGULATION IN ADULTS WITH TRAUMATIC BRAIN INJURY: A NOVEL ECOLOGICAL MOMENTARY ASSESSMENT METHOD

Each year in the United States 2.5 million people sustain a traumatic brain injury (TBI), making TBI one of the leading causes of death and disability. Difficulty self-regulating behavior is considered a hallmark deficit of TBI and can impede positive rehabilitation outcomes. Traditional clinic-based assessments with TBI cohorts are often compromised due to inaccurate self-reporting caused by self-awareness and/or memory challenges. This project developed out of the need for more adequate and objective assessment methods of behavior after TBI. The aim of this study was to identify physiological states that may serve as real world, real-time prodromes of behavioral dysregulation when compared to direct behavioral observation during task performance. Adults with TBI (N=14) were asked to complete a protocol of challenging, problem-solving tasks selected due to their potential to elicit negative responses believed to be indicative of dysregulation and result in task breakdown behaviors. Participants wore a portable biosensor band throughout the completion of all research tasks, which allowed for continuous physiological recordings of heart rate, breathing rate, and heart rate variability. Physiology was then synchronized with post hoc behavioral ratings conducted by trained clinicians from video recordings and analyzed through hierarchical linear mixed model methods to assess both between- and within-subject contribution related to the outcome. Testing was conducted at ReMed of Pittsburgh, a community-based brain injury rehabilitation program. This study was funded in part through the National Science Foundation’s Integrative Graduate Education & Research Traineeship (IGERT) Program in the Department of Rehabilitation Science & Technology and the School of Health & Rehabilitation Sciences Dean’s Research Development Fund, all at the University of Pittsburgh

Continuous monitoring of health and mobility indicators in patients with cardiovascular disease: a review of recent technologies

Cardiovascular diseases kill 18 million people each year. Currently, a patient’s health is assessed only during clinical visits, which are often infrequent and provide little information on the person’s health during daily life. Advances in mobile health technologies have allowed for the continuous monitoring of indicators of health and mobility during daily life by wearable and other devices. The ability to obtain such longitudinal, clinically relevant measurements could enhance the prevention, detection and treatment of cardiovascular diseases. This review discusses the advantages and disadvantages of various methods for monitoring patients with cardiovascular disease during daily life using wearable devices. We specifically discuss three distinct monitoring domains: physical activity monitoring, indoor home monitoring and physiological parameter monitoring