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

Virtual reality environments as a therapeutic technique in rehabilitation of physical and cognitive training in soccer players

Um dos principais problemas dos jogadores de futebol são as lesões que sofrem durante a carreira. Por isso, os clubes profissionais investem em equipas médicas especializadas para contornar esse problema. Com a evolução das tecnologias interativas, têm sido muito os estudos para resolver esse problema e trazer mais opções para o campo científico. Apesar desse esforço, ainda faltam estudos sobre a introdução de tecnologias interativas nesses contextos. Desenvolvemos um sistema para testar se o uso dessas novas tecnologias, mais especificamente a realidade virtual, poderia trazer mais motivação e evitar a monotonia de atletas profissionais na realização de exercícios de reabilitação. Ao longo desta dissertação, iremos explicar todos os processos que foram realizados até chegar ao sistema atual. A explicação do processo inclui os exercícios de reabilitação física escolhidos, bem como o desenvolvimento do software que os envolve. Os estudos realizados durante esta tese revelaram feedback positivo entre os atletas e há potencial de trabalho futuro em termos de utilidade do sistema.One of the main problems of football players is the injuries they suffer during their careers. For that reason, professional clubs invest in specialized medical staff to overpass this problem. With the evolution of interactive technologies, many studies have been made to address this problem and bring more options to the scientific field. Despite this effort, there is still a lack of studies regarding the introduction of interactive technologies in these contexts. We developed a system to test whether the usage of these new technologies, more specifically virtual reality, could bring better motivation and avoid monotony in professional athletes when performing rehabilitation exercises. Throughout this dissertation, we will explain all the processes that were performed until reaching the current system. The explanation of the process includes the physical rehabilitation exercises chosen, as well as the software development entailing those exercises. The studies performed during this thesis revealed positive feedback among athletes and there is future work potential in terms of the usefulness of the system

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

PhysioAR: smart sensing and augmented reality for physical rehabilitation

The continuous evolution of technology allows for a better analysis of the human being. In certain medical areas such as physiotherapy is required a correct analysis of the patient's evolution. The development of Information and Communication Technologies and recent innovations in the Internet of Things opens new possibilities in the medical field as systems of remote monitoring of patients with new sensors that allow the correct analysis of the health data of patients. In physiotherapy one of the most common problems in the application of treatments is the patient demotivation, something that today can be reduced with the introduction of Augmented Reality that provides a new experience to the patient. For this purpose, a system was developed that combines intelligent sensors with Augmented Reality application that will help monitor patient performance. This system is capable of monitoring lower limb movements acceleration, knee joint angle, patient equilibrium, muscular activity and cardiac activity using electromyography and electrocardiography with a wearable set of tools for easy utilization.A evolução continua da tecnologia permite cada vez mais uma melhor análise do ser humano. Em certas áreas médicas, como a fisioterapia, é necessária uma correta análise da evolução do paciente. O desenvolvimento das Tecnologias de Informação e Comunicação, e as inovações no domínio de Internet das Coisas novas possibilidades no ramo da medicina, como sistemas de monitorização remota de pacientes com novos sensores que permitem a correta análise dos dados de saúde dos pacientes. Na fisioterapia um dos problemas mais comuns na aplicação dos tratamentos é a desmotivação do paciente, algo que hoje pode ser reduzido com introdução da aplicação da Realidade Aumentada que proporciona uma nova experiência ao paciente. Para isso nesta dissertação foi desenvolvido um sistema que combina sensores inteligentes com Realidade Aumentada que vai ajudar o paciente monitorizando o seu desempenho. Este sistema é capaz de monitorizar o ângulo do joelho, captar acelaração de movimentos dos membros inferiores, equilíbrio do paciente, atividade muscular e atividade cárdica usando electromiografia e electrocardiografia num conjunto wearable de fácil utilização

Realidade virtual para reabilitação pós-avc: estudos de utilizadores e desenvolvimento de jogos

Stroke is one of the leading causes of disability and death in the world, and rehabilitation is a relevant part of the life of stroke survivors. Physical therapy is necessary to recover some movement during the acute phase, but also to maintain muscle strength and avoid deterioration and weakness during the chronic phase. The global pandemic caused shortages of rehabilitation activities, and Virtual Reality (VR) games could be used as a complementary type of therapy for stroke rehabilitation to be used at home. This dissertation proposes a user study to better understand the needs and preferences of stroke survivors and the development of game prototypes to better ascertain the potential of VR-based serious games. With this goal, a Questionnaire and a Focus Group were done with survivors, and based on their results, two VR-based game prototypes were developed, focused on the movements that survivors need to perform as well as providing an equivalent to Mirror Therapy. This study found that stroke survivors in chronic stage are more interested in applications based on real-world activities, especially activities they used to perform before the onset symptoms. Negative feedback is also an issue they prefer to avoid based on mental health conditions commonly associated with stroke. The game prototypes were tested concerning usability and were scored high with healthy participants on the System Usability Scale when performed normally, but low when their movements were mirrored, though perhaps survivors are more used to this kind of exercise. The performance of the game prototypes needs improvement, but they were considered easy to use and to learn. The next step will be an evaluation of the improved versions by stroke survivors.O AVC é uma das principais causas de invalidez e morte no mundo, e a reabilitação é uma parte relevante da vida dos sobreviventes do AVC. A fisioterapia é necessária para recuperar algum movimento durante a fase aguda, mas também para manter a força muscular e evitar a deterioração e fraqueza durante a fase crónica. A pandemia global causou escassez de atividades de reabilitação, e jogos de Realidade Virtual (RV) poderiam ser usados como um tipo complementar de terapia para reabilitação de AVC com o uso em casa. Esta dissertação propõe um Estudo com Utilizadores para melhor compreender as necessidades e preferências de sobreviventes do AVC e o desenvolvimento de protótipos de jogos para melhor averiguar o potencial de jogos sérios baseados em RV. Com este objetivo, um Questionário e um Grupo Focal foram feitos com os sobreviventes e, com base em seus resultados, dois protótipos de jogos baseados em RV foram desenvolvidos, focados nos movimentos que os sobreviventes precisam realizar, além de fornecer um modo equivalente à Terapia do Espelho. Este estudo descobriu que sobreviventes de AVC em estágio crónico estão mais interessados em aplicações baseadas em atividades do mundo real, especialmente atividades que eles costumavam realizar antes do início dos sintomas. O feedback negativo também é um problema que eles preferem evitar com base nas condições de saúde mental comumente associadas ao AVC. Os protótipos do jogo foram testados com base em usabilidade e pontuaram alto com os participantes saudáveis na Escala de Usabilidade do Sistema quando executados normalmente, mas pontuaram baixo quando seus movimentos foram espelhados, embora talvez os sobreviventes estejam mais acostumados a esse tipo de exercício. O desempenho dos protótipos de jogos precisa de melhorias, mas eles foram considerados fáceis de usar e aprender. O próximo passo será a avaliação de versões melhoradas por sobreviventes de AVC.Mestrado em Engenharia Informátic

Feasibility of ActivABLES to promote home-based exercise and physical activity of community-dwelling stroke survivors with support from caregivers : A mixed methods study

BackgroundTechnical applications can promote home-based exercise and physical activity of community-dwelling stroke survivors. Caregivers are often able and willing to assist with home-based exercise and physical activity but lack the knowledge and resources to do so. ActivABLES was established to promote home-based exercise and physical activity among community-dwelling stroke survivors, with support from their caregivers. The aim of our study is to investigate the feasibility of ActivABLES in terms of acceptability, demand, implementation and practicality.MethodsA convergent design of mixed methods research in which quantitative results were combined with personal experiences of a four-week use of ActivABLES by community-dwelling stroke survivors with support from their caregivers. Data collection before, during and after the four-week period included the Berg Balance Scale (BBS), Activities-Specific Balance Confidence Scale (ABC), Timed-Up-and-Go (TUG) and Five Times Sit to Stand Test (5xSST) and data from motion detectors. Semi-structured interviews were conducted with stroke survivors and caregivers after the four-week period. Descriptive statistics were used for quantitative data. Qualitative data was analysed with direct content analysis. Themes were identified related to the domains of feasibility: acceptability, demand, implementation and practicality. Data was integrated by examining any (dis)congruence in the quantitative and qualitative findings.ResultsTen stroke survivors aged 55-79years participated with their informal caregivers. Functional improvements were shown in BBS (+2.5), ABC (+0.9), TUG (-4.2) and 5xSST (-2.7). More physical activity was detected with motion detectors (stand up/sit down +2, number of steps +227, standing +0.3h, hours sitting/lying -0.3h). The qualitative interviews identified themes for each feasibility domain: (i) acceptability: appreciation, functional improvements, self-initiated activities and expressed potential for future stroke survivors; (2) demand: reported use, interest in further use and need for follow-up; (3) implementation: importance of feedback, variety of exercises and progression of exercises and (4) practicality: need for support and technical problems. The quantitative and qualitative findings converged well with each other and supported the feasibility of ActivABLES.ConclusionsActivABLES is feasible and can be a good asset for stroke survivors with slight or moderate disability to use in their homes. Further studies are needed with larger samples.Peer reviewe

Virtual rehabilitation: what are the practical barriers for home-based research?

Virtual reality technologies are becoming increasingly accessible and affordable to deliver, and consequently the interest in applying virtual reality within rehabilitation is growing. This has resulted in the emergence of research exploring the utility of virtual reality and interactive video gaming interventions for home use by patients. The aim of this paper is to highlight the practical factors and difficulties that may be encountered in research in this area, and to make recommendations for addressing these. Whilst this paper focuses on examples drawn mainly from stroke rehabilitation research, many of the issues raised are relevant to other conditions where virtual reality approaches have the potential to be applied to home-based rehabilitation