Give Me Shelter: Responding to Milwaukee County's affordable housing challenges

Few issues better capture the complex and controversial nature of urban problems facing Metropolitan Milwaukee than the issue of affordable housing. Encompassing matters of racial segregation, poverty and failed public-private partnerships, the Milwaukee metro area's struggle to provide a safe, decent and affordable supply of housing to low-income citizens has been a difficult one. Even before the national economic meltdown, countless reports documented the severe housing burden facing low-income citizens in Milwaukee County. That burden, combined with the scarcity of affordable housing in suburban parts of southeast Wisconsin, has cemented the region's place as one of the most racially segregated in the country. In today's economy, those problems have intensified

Remote Rehabilitation: A solution to Overloaded & Scarce Health Care Systems

The population across Northern Europe is aging. Coupled with socio-economic challenges, health care systems are at risk of overloading and incurring unsustainable high costs. Rehabilitation services are used disproportionately by older people. One solution pertinent to rural areas is to change the model of rehabilitation to incorporate new technologies. This has the potential to free resources and reduce costs. However, implementation is challenging. In the Northern Periphery and Artic Programme (NPA), the Smart sensor Devices for rehabilitation and Connected health (SENDoc) project [1] is focused on introducing wearable sensor systems among elderly communities to support their rehabilitation. It is important to understand the context into which change is introduced. Therefore, an overview of the current state of health care systems in the four partner countries is presented, defining the concept of rehabilitation and how remote rehabilitation is currently delivered. Advantages (e.g. enhanced outcomes, less cost and enhanced patient engagement), and disadvantages of remote rehabilitation (e.g. complexity involved in the use of technology, design and safety issues) are discussed. It is concluded that the key advantage of remote rehabilitation is the potential to support change in patient behaviour, empowering active participation and living independently, with less need to travel for face-to-face sessions. Remote rehabilitation can make enhance quality of health care service delivery. However, all relevant stakeholders including medical staff and patients should be included in the design of the technology employed with a focus on simplicity, usability and robustness. Compliance with Security and the new GDPR regulation will be key to supporting remote rehabilitation. In addition, the diversity of available platforms and devices must also be supported to ensure interoperability. Finally, remote rehabilitation needs to be further validated in practice. Attempts to implement and sustain change should be cognisant of local and current organization of health care and of existing enablers and barriers

Rehabilitation:mobility, exercise & sports; a critical position stand on current and future research perspectives

Background Human movement, rehabilitation, and allied sciences have embraced their ambitions within the cycle of “RehabMove” congresses over the past 30 years. This combination of disciplines and collaborations in the Netherlands has tried to provide answers to questions in the fields of rehabilitation and adapted sports, while simultaneously generating new questions and challenges. These research questions help us to further deepen our understanding of (impaired) human movement and functioning, with and without supportive technologies, and stress the importance of continued multidisciplinary (inter)national collaboration. Methods This position stand provides answers that were conceived by the authors in a creative process underlining the preparation of the 6th RehabMove Congress. Results The take-home message of the RehabMove2018 Congress is a plea for continued multidisciplinary research in the fields of rehabilitation and adapted sports. This should be aimed at more individualized notions of human functioning, practice, and training, but also of performance, improved supportive technology, and appropriate “human and technology asset management” at both individual and organization levels and over the lifespan. Conclusions With this, we anticipate to support the development of rehabilitation sciences and technology and to stimulate the use of rehabilitation notions in general health care. We also hope to help ensure a stronger embodiment of preventive and lifestyle medicine in rehabilitation practice. Indeed, general health care and rehabilitation practice require a healthy and active lifestyle management and research agenda in the context of primary, secondary, and tertiary prevention. IMPLICATIONS FOR REHABILITATION Continued multidisciplinary (international) collaboration will stimulate the development of rehabilitation and human movement sciences. Notions from “human and technology asset management and ergonomics” are fundamental to rehabilitation practice and research. The rehabilitation concept will further merge into general health care and the quality there-off

Telerehabilitation in the Middle East North Africa Region: A Structured Review

A structured review using the PRISMA guidelines, MeSH keywords and eight health databases was conducted (1990 to March 2021). Telerehabilitation research evidence from the Middle East and North Africa region (MENA) was summarized. Twelve studies from Iran, Israel, Morocco, and Saudi Arabia met inclusion criteria; nearly all had been published within the past five years. Methodological quality was moderate to good in the four randomized controlled trials, five cohort-studies and three cross-section surveys. There were seven intervention studies in cardiovascular, musculoskeletal, neurology or burn rehabilitation and three patient perception and two practitioner perception studies. Narrative synthesis revealed content themes relating to rehabilitation availability and accessibility; patient/practitioner perceptions of telerehabilitation; telerehabilitation to augment traditional services; and barriers to telerehabilitation. Telerehabilitation practice in MENA has been demonstrated as feasible, acceptable to patients, and effective in practitioner-designed cohort specific programs. Practitioners are generally positive but lack experience and need training, enabling technological systems, and policy frameworks. &nbsp

A Personalized Self-Management Rehabilitation System for Stroke Survivors: A Quantitative Gait Analysis Using a Smart Insole.

Background: In the United Kingdom, stroke is the single largest cause of adult disability and results in a cost to the economy of £8.9 billion per annum. Service needs are currently not being met; therefore, initiatives that focus on patient-centered care that promote long-term self-management for chronic conditions should be at the forefront of service redesign. The use of innovative technologies and the ability to apply these effectively to promote behavior change are paramount in meeting the current challenges. Objective: Our objective was to gain a deeper insight into the impact of innovative technologies in support of home-based, self-managed rehabilitation for stroke survivors. An intervention of daily walks can assist with improving lower limb motor function, and this can be measured by using technology. This paper focuses on assessing the usage of self-management technologies on poststroke survivors while undergoing rehabilitation at home. Methods: A realist evaluation of a personalized self-management rehabilitation system was undertaken in the homes of stroke survivors (N=5) over a period of approximately two months. Context, mechanisms, and outcomes were developed and explored using theories relating to motor recovery. Participants were encouraged to self-manage their daily walking activity; this was achieved through goal setting and motivational feedback. Gait data were collected and analyzed to produce metrics such as speed, heel strikes, and symmetry. This was achieved using a “smart insole” to facilitate measurement of walking activities in a free-living, nonrestrictive environment. Results: Initial findings indicated that 4 out of 5 participants performed better during the second half of the evaluation. Performance increase was evident through improved heel strikes on participants’ affected limb. Additionally, increase in performance in relation to speed was also evident for all 5 participants. A common strategy emerged across all but one participant as symmetry performance was sacrificed in favor of improved heel strikes. This paper evaluates compliance and intensity of use. Conclusion: Our findings suggested that 4 out of the 5 participants improved their ability to heel strike on their affected limb. All participants showed improvements in their speed of gait measured in steps per minute with an average increase of 9.8% during the rehabilitation program. Performance in relation to symmetry showed an 8.5% average decline across participants, although 1 participant improved by 4%. Context, mechanism, and outcomes indicated that dual motor learning and compensatory strategies were deployed by the participants

Assessing Self-Rehabilitation Strategies for the Visually Impaired in Denmark

Self-rehabilitation technology has been developed to reduce healthcare costs and provide a convenient, reliable method for patients to recover from a physical injury. Sponsored by the Danish Association of the Blind, the following report summarizes a project exploring self-rehabilitation technologies that can accommodate blind or visually impaired patients. Potential strategies to increase awareness of such devices throughout municipalities in Denmark were evaluated as well. The data collected in this project were used to recommend that the Danish Association of the Blind advocates for further development of several rehabilitation technologies and the education of healthcare professionals about these technologies throughout Danish municipalities

IoT based model of healthcare for physiotherapy

Trabalho apresentado em 13th International Conference on Sensing Technology (ICST 2019), dezembro 2019, Sydney, Austrália.Small and reliable devices that are used not only in clinics or hospital but also in home, give information on movements, activities or other relevant data on person health and functioning. The data acquired by these devices would increase the accessibility to healthcare services and quality of care, in a safe environment. There are scarce data related to integration of Internet of Things (IoT) technologies into information system for physiotherapy or motor rehabilitation. In this work it is presented a framework for IoT based information system for physiotherapy. The presented model for physiotherapy includes: the capacity of IoT based information system to receive inputs from different modalities; support for modularity and common communication technologies for IoT; gateway capabilities and/or edge computing; data storage and analysis in Server, Cloud Server or Microservices. Research is needed for better understanding what is the optimal model and architecture for IoT platforms targeting people with different types of disabilities, as well as an optimal universal design that may increase the quality of care for people with disability.info:eu-repo/semantics/publishedVersio

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

The Effects of Dynamic Decision Making on Resource Allocation: The Case of Pavement Management

Pavement performance is a broad term that tries to describe how changing usage and varying conditions effect changes in pavement conditions. Measures of performance such as the Pavement Serviceability Index (PSI), the Pavement Condition Index (PCI) or Pavement Quality Index are available for use. Modeling pavement management is an essential activity of a pavement management system. Currently, models are used in the pavement planning and budget development process, as well as in helping to determine pavement life cycle management (George, Rajagopal, and Lim 1989). This process provides a means to plan for both routine maintenance and full rehabilitation of current roads. Maintaining these roads in good order is essential to providing a safe and rapid means of ground transportation in order to support both the current and future economic needs of our communities. System Dynamics is a simulation modeling process that was developed by Jay Forrester while at MIT. The modeling process allows the modeler to capture both the structure of the system under study and the decision rules used by members of the system that affect the behavior of the system. The modeling process is based on the concept that real world systems are non-linear in nature and the results of actions taken feedback and effect the system necessitating new actions. The objective of this study will be to use the System Dynamics modeling process to: Determine if and how current pavement management practices contribute to problems that pavement managers deal with on a day to day basis. Develop a set of recommendations to improve those practices that are found to contribute to or create the problem. Provide a tool that pavement managers can use to test their own proposed changes to their management practices in the form of a simulated environment

From chaos to clarity : designing eHealth to support self-management in stroke care

Introduction: Currently healthcare is shifting from a paternalistic model to a more patient-centered model in which patients’ involvement and self-management play a crucial role. Information and communication technology has the potential to shift the balance of power and responsibility from healthcare professionals to patients and citizens. To provide patients with health information systems and eHealth services which meet their needs and support them throughout their care and rehabilitation processes, there is a need of involving them not only in their care processes but also in the design and evaluation of eHealth. Aim: The overall aim of this research was to explore how a health information system or eHealth service (in this context an electronic care and rehabilitation planning tool) used by post-discharge stroke patients can be designed to improve patient self-management and collaboration between patients, their next-of-kin and different care professionals. Methods: A design research strategy was employed in this thesis project where an online care and rehabilitation planning was designed and evaluated to contribute to the knowledge base on patient involvement in both design of eHealth and in their care through use of eHealth. In study I, the current care and rehabilitation processes of post-discharge stroke patients in Stockholm County Council were explored using a qualitative case study. Data were collected through interviews and observations. Study II explored the stroke patients’ information needs and potential eHealth services were suggested by the researchers and discussed with the patients. An interactive prototype ‘My care plan’ was designed and improved based on the participants’ input. Data for this study were collected through focus groups and usability tests. Study III was mainly a document study where the authors explored the Swedish current infrastructure for health information exchange. In study IV, the prototype was evaluated from both care professionals’ and aphasia patients’ perspective. Results: Based on the patients’ risk factors and disabilities, post-discharge stroke patients’ involvement throughout the care and rehabilitation processes varied significantly. The analysis of patients’ information needs resulted in design of an interactive care and rehabilitation planning tool ‘My care plan’ which consisted mainly of a rehabilitation plan and necessary health and administrative information. The results from the evaluation of the care and rehabilitation planning tool showed that despite some challenges and limitations with using the tool, both care professionals and stroke patients were positive towards using it. The Swedish national health information exchange platform provides opportunities for information exchange, however needs to be further evaluated from a patient perspective to determine how it can support and impact on patient empowerment and collaboration in care. Conclusions: The main contribution of this thesis is involvement of chronically ill patients suffering from several cognitive and physical disabilities in the design and evaluation of eHealth services. Despite several challenges throughout this research project, a deep understanding about this patient group’s needs throughout their care and rehabilitation processes was gained. The thesis also provides an early exploration of the Swedish national health information exchange platform. As this is an area rapidly evolving and of high priority in Sweden today, the results presented in this thesis will provide important input to future research, development and policy in this field