Home-based Rehabilitation With A Novel Digital Biofeedback System versus Conventional In-person Rehabilitation after Total Knee Replacement: a feasibility study

In-person home-based rehabilitation and telerehabilitation can be as effective as clinic-based rehabilitation after total knee arthroplasty (TKA), but require heavy logistics and are highly dependent on human supervision. New technologies that allow independent home-based rehabilitation without constant human supervision may help solve this problem. This was a single-center, feasibility study comparing a digital biofeedback system that meets these needs against conventional in-person home-based rehabilitation after TKA over an 8-week program. Primary outcome was the change in the Timed Up and Go score between the end of the program and baseline. Fifty-nine patients completed the study (30 experimental group; 29 conventional rehabilitation). The study demonstrated a superiority of the experimental group for all outcomes. Adverse events were similar in both groups. This is the first study to demonstrate that a digital rehabilitation solution can achieve better outcomes than conventional in-person rehabilitation, while less demanding in terms of human resources.his work was supported by the European Commission through the Project H2020 SME Instrument Phase 2 - Grant Agreement number 672814.info:eu-repo/semantics/publishedVersio

SWORD: um dispositivo vibratório vestível para uma rabilitação mais eficiente em doentes com AVC

Doutoramento em Engenharia ElectrotécnicaAnualmente ocorrem cerca de 16 milhões AVCs em todo o mundo. Cerca de metade dos sobreviventes irá apresentar défice motor que necessitará de reabilitação na janela dos 3 aos 6 meses depois do AVC. Nos países desenvolvidos, é estimado que os custos com AVCs representem cerca de 0.27% do Produto Interno Bruto de cada País. Esta situação implica um enorme peso social e financeiro. Paradoxalmente a esta situação, é aceite na comunidade médica a necessidade de serviços de reabilitação motora mais intensivos e centrados no doente. Na revisão do estado da arte, demonstra-se o arquétipo que relaciona metodologias terapêuticas mais intensivas com uma mais proficiente reabilitação motora do doente. Revelam-se também as falhas nas soluções tecnológicas existentes que apresentam uma elevada complexidade e custo associado de aquisição e manutenção. Desta forma, a pergunta que suporta o trabalho de doutoramento seguido inquire a possibilidade de criar um novo dispositivo de simples utilização e de baixo custo, capaz de apoiar uma recuperação motora mais eficiente de um doente após AVC, aliando intensidade com determinação da correcção dos movimentos realizados relativamente aos prescritos. Propondo o uso do estímulo vibratório como uma ferramenta proprioceptiva de intervenção terapêutica a usar no novo dispositivo, demonstra-se a tolerabilidade a este tipo de estímulos através do teste duma primeira versão do sistema apenas com a componente de estimulação num primeiro grupo de 5 doentes. Esta fase validará o subsequente desenvolvimento do sistema SWORD. Projectando o sistema SWORD como uma ferramenta complementar que integra as componentes de avaliação motora e intervenção proprioceptiva por estimulação, é descrito o desenvolvimento da componente de quantificação de movimento que o integra. São apresentadas as diversas soluções estudadas e o algoritmo que representa a implementação final baseada na fusão sensorial das medidas provenientes de três sensores: acelerómetro, giroscópio e magnetómetro. O teste ao sistema SWORD, quando comparado com o método de reabilitação tradicional, mostrou um ganho considerável de intensidade e qualidade na execução motora para 4 dos 5 doentes testados num segundo grupo experimental. É mostrada a versatilidade do sistema SWORD através do desenvolvimento do módulo de Tele-Reabilitação que complementa a componente de quantificação de movimento com uma interface gráfica de feedback e uma ferramenta de análise remota da evolução motora do doente. Finalmente, a partir da componente de quantificação de movimento, foi ainda desenvolvida uma versão para avaliação motora automatizada, implementada a partir da escala WMFT, que visa retirar o factor subjectivo da avaliação humana presente nas escalas de avaliação motora usadas em Neurologia. Esta versão do sistema foi testada num terceiro grupo experimental de cinco doentes.About 16 million first ever-strokes occur worldwide every year. Half of stroke survivors are left with some degree of physical impairment that needs rehabilitation in the 3 to 6 month after-stroke time window. This situation implies a high economic and social burden. In developed countries, stroke cost is estimated to represent an average of 0.27% of each country’s gross domestic product. Paradoxically, it is accepted in the medical community the need for more intensive and patient-centered rehabilitation services. In the state of art review, it is demonstrated the archetype that relates the intensity on rehabilitation with a proficient motor recovery of the patient. Additionally, it is shown that the major pitfalls in current technological solutions in the field of motor rehabilitation are due to their intrinsic complexity and associated cost. Given this state of the art, the research question that supports this thesis, inquiries the possibility of creating a novel low-cost device targeted at the motor rehabilitation of stroke patients, capable of providing a more efficient treatment through enabling higher intensity and automated determination of the correctness of the movements performed by the recovering patient. The validity of the vibratory stimulus is presented from an historic and neurophysiologic point of view. Furthermore, a state of art review of motion capture systems is presented. Intending the use of the vibratory stimulus as a proprioceptive therapeutic tool to be integrated in the new device, it is demonstrated the tolerability of the stimulus from the experimental test of a first version of the device, incorporating the stimulation component, in a first group of five patients. Projecting the SWORD device as a tool that combines both features of motor function evaluation with proprioceptive intervention through vibratory stimulation, it is described the development of the motion capture component. Several solutions were studied and the final algorithm, based on the sensory fusion of the measures from three sensors (accelerometer, gyroscope and magnetometer), is described in detail. The experimental test of the SWORD system on a second group of patients showed that, when compared with a typical treatment, it is capable of providing a more intensive intervention and with a higher quality in 4 out of 5 patients. To demonstrate the versatility of the SWORD system, it was developed the tele-rehabilitation module that complements the motion capture component with a graphical feedback interface and a remote tool for the clinician to evaluate the performance of the patient through out the time he uses the system in his home or any other remote environment. Finally, from the motion capture component, a motor function evaluation version of the system was deployed. Implemented from the WMFT scale, it aims to eliminate the human subjectivity present in the traditional evaluation scales used in the neurology medical area. This system was evaluated on a third group of five patients

The use of UTAUT and Post Acceptance models to investigate the attitude towards a telepresence robot in an educational setting

(1) Background: In the last decade, various investigations into the field of robotics have created several opportunities for further innovation to be possible in student education. However, despite scientific evidence, there is still strong scepticism surrounding the use of robots in some social fields, such as personal care and education; (2) Methods: In this research, we present a new tool named: HANCON model that was developed merging and extending the constructs of two solid and proven models: the Unified Theory of Acceptance and Use of Technology (UTAUT) model to examine the factors that may influence the decision to use a telepresence robot as an instrument in educational practice, and the Post Acceptance Model to evaluate acceptability after the actual use of a telepresence robot. The new tool is implemented and used to study the acceptance of a Double telepresence robot by 112 pre-service teachers in an educational setting; (3) Results: The analysis of the experimental results predicts and demonstrate a positive attitude towards the use of telepresence robot in a school setting and confirm the applicability of the model in an educational context; (4) Conclusions: The constructs of the HANCON model could predict and explain the acceptance of social telepresence robots in social contexts

Pragmatism or What? The Future of US Foreign Policy

This article discusses the intellectual sources of the presidential candidates' foreign policies. In the case of Barack Obama, the article examines the formation of his worldview, his intellectual inspirations, his most significant foreign policy appointments and the diplomatic course he has pursued as president. Mitt Romney's foreign policy views are harder to identify with certainty, but his business and political career-as well as the identity and dispositions of his advisory team-all provide important clues as to the policies he will pursue if elected in November 2012. The article finds much common ground between the two candidates; both are results-driven pragmatists, attuned to nuance and complexity, who nonetheless believe-in agreement with Robert Kagan-that US geostrategic primacy will continue through the span of the twenty-first century. The gulf between the candidates on domestic policy is vast, but on foreign policy-Romney's bellicose statements through the Republican primaries served a purpose that has passed-there is little between the

European Respiratory Society Statement on Long COVID-19 Follow-Up

Patients diagnosed with COVID-19 associated with SARS-CoV-2 infection frequently experience symptom burden post-acute infection or post-hospitalisation. We aim to identify optimal strategies for follow-up care that may positively impact the patient's quality-of-life (QOL).A European Respiratory Society (ERS) Task Force (TF) convened and prioritised eight clinical questions. A targeted search of the literature defined the time line of long COVID-19 as one to six months post infection and identified clinical evidence in the follow-up of patients. Studies meeting the inclusion criteria report an association of characteristics of acute infection with persistent symptoms, thromboembolic events in the follow-up period and evaluations of pulmonary physiology and imaging. Importantly, this statement reviews QOL consequences, symptom burden, disability and home care follow-up. Overall, the evidence for follow-up care for patients with long COVID-19 is limited

Studying and Treating Schizophrenia Using Virtual Reality: A New Paradigm

Understanding schizophrenia requires consideration of patients’ interactions in the social world. Misinterpretation of other peoples’ behavior is a key feature of persecutory ideation. The occurrence and intensity of hallucinations is affected by the social context. Negative symptoms such as anhedonia, asociality, and blunted affect reflect difficulties in social interactions. Withdrawal and avoidance of other people is frequent in schizophrenia, leading to isolation and rumination. The use of virtual reality (VR)—interactive immersive computer environments—allows one of the key variables in understanding psychosis, social environments, to be controlled, providing exciting applications to research and treatment. Seven applications of virtual social environments to schizophrenia are set out: symptom assessment, identification of symptom markers, establishment of predictive factors, tests of putative causal factors, investigation of the differential prediction of symptoms, determination of toxic elements in the environment, and development of treatment. The initial VR studies of persecutory ideation, which illustrate the ascription of personalities and mental states to virtual people, are highlighted. VR, suitably applied, holds great promise in furthering the understanding and treatment of psychosis

Universal Design: Planning and Design for All

[Excerpt] This report attempts to develop and illustrate the concept of universal design. The aim of universal design is to develop theory, principles and solutions to enable everybody to use the same physical solutions to the greatest extent possible, whether it be buildings, outdoor-areas, means of communication or household goods. Universal design opposes, ideologically and politically, all unnecessary and stigmatizing specialized solutions, whether they are intended for people with disabilities or other groups of the population. Equal status, equal treatment and equal merit are key concepts. The discussion in this report covers extensive spheres such as planning, architecture and product design. One may object that we try to cover too large an area within a relatively brief report. It is therefore important to emphasise that our main intention is to include more professionals and politicians in the further discussion of universal design or design for all