Development and preliminary evaluation of a novel low cost VR-based upper limb stroke rehabilitation platform using Wii technology.

Abstract Purpose: This paper proposes a novel system (using the Nintendo Wii remote) that offers customised, non-immersive, virtual reality-based, upper-limb stroke rehabilitation and reports on promising preliminary findings with stroke survivors. Method: The system novelty lies in the high accuracy of the full kinematic tracking of the upper limb movement in real-time, offering strong personal connection between the stroke survivor and a virtual character when executing therapist prescribed adjustable exercises/games. It allows the therapist to monitor patient performance and to individually calibrate the system in terms of range of movement, speed and duration. Results: The system was tested for acceptability with three stroke survivors with differing levels of disability. Participants reported an overwhelming connection with the system and avatar. A two-week, single case study with a long-term stroke survivor showed positive changes in all four outcome measures employed, with the participant reporting better wrist control and greater functional use. Activities, which were deemed too challenging or too easy were associated with lower scores of enjoyment/motivation, highlighting the need for activities to be individually calibrated. Conclusions: Given the preliminary findings, it would be beneficial to extend the case study in terms of duration and participants and to conduct an acceptability and feasibility study with community dwelling survivors. Implications for Rehabilitation Low-cost, off-the-shelf game sensors, such as the Nintendo Wii remote, are acceptable by stroke survivors as an add-on to upper limb stroke rehabilitation but have to be bespoked to provide high-fidelity and real-time kinematic tracking of the arm movement. Providing therapists with real-time and remote monitoring of the quality of the movement and not just the amount of practice, is imperative and most critical for getting a better understanding of each patient and administering the right amount and type of exercise. The ability to translate therapeutic arm movement into individually calibrated exercises and games, allows accommodation of the wide range of movement difficulties seen after stroke and the ability to adjust these activities (in terms of speed, range of movement and duration) will aid motivation and adherence - key issues in rehabilitation. With increasing pressures on resources and the move to more community-based rehabilitation, the proposed system has the potential for promoting the intensity of practice necessary for recovery in both community and acute settings.The National Health Service (NHS) London Regional Innovation Fund

Home-based physical therapy with an interactive computer vision system

In this paper, we present ExerciseCheck. ExerciseCheck is an interactive computer vision system that is sufficiently modular to work with different sources of human pose estimates, i.e., estimates from deep or traditional models that interpret RGB or RGB-D camera input. In a pilot study, we first compare the pose estimates produced by four deep models based on RGB input with those of the MS Kinect based on RGB-D data. The results indicate a performance gap that required us to choose the MS Kinect when we tested ExerciseCheck with Parkinson’s disease patients in their homes. ExerciseCheck is capable of customizing exercises, capturing exercise information, evaluating patient performance, providing therapeutic feedback to the patient and the therapist, checking the progress of the user over the course of the physical therapy, and supporting the patient throughout this period. We conclude that ExerciseCheck is a user-friendly computer vision application that can assist patients by providing motivation and guidance to ensure correct execution of the required exercises. Our results also suggest that while there has been considerable progress in the field of pose estimation using deep learning, current deep learning models are not fully ready to replace RGB-D sensors, especially when the exercises involved are complex, and the patient population being accounted for has to be carefully tracked for its “active range of motion.”Published versio

TRANSITIONING A HAND THERAPY CLINIC FROM TRADITIONAL PAPER HOME PROGRAMS TO AN ELECTRONIC PLATFORM: A QUALITY IMPROVEMENT PROJECT

Individuals with upper extremity conditions who receive occupational therapy within the hand therapy context are often provided with paper or electronic home programs (HPs) as part of their rehabilitation protocol. Electronic HPs may promote greater adherence and functional improvements than paper handouts, as they can accommodate various learning styles and address patient barriers (Chung et al., 2020; Harte & Law, 2019; Lambert et al., 2017; Nussbaum et al., 2019; Toci et al., 2021; Valdes et al., in press). Despite evidence showing positive patient satisfaction and outcomes as a result of using electronic HPs, some occupational therapy practitioners (OTPs) may be hesitant to use a new online system (Corey, 2019; Choi et al., 2019; Svingen et al., 2021). The purpose of this scholarly project is to help transition an outpatient hand therapy clinic from using traditional paper HPs to using MedBridge by offering therapists educational resources. Several methods were used to understand the potential impact of this project on patient care and to understand practitioners’ opinions regarding MedBridge. The person-environment-occupation (PEO) model and the plan-do-study-act (PDSA) quality improvement (QI) method were considered throughout the literature review and formation of the product (Law et al., 1996; Taylor et al., 2014). An in-service presentation was provided to orient therapists to basic functions when using MedBridge HPs. Additionally, the MedBridge Home Exercise Program User Guide was developed which provides an in-depth explanation of the purpose of each function and how to use it, and the MedBridge Home Exercise Program Quick Reference card offers a brief overview of the necessary steps in building a home program. It is anticipated that the resources made available to therapists on MedBridge as well as the user guide will increase therapists’ use of electronic HPs which may improve overall patient satisfaction and functional outcomes

A Personal Perspective on Daily Occupations to Counteract Cancer Related Fatigue: A Case Study

Background: This case study aimed to identify and describe meaningful physical occupations used by a cancer survivor to increase or maintain levels of participation during active chemotherapy and subsequent cancer related fatigue. Method: A case study approach was used to develop an in-depth description and analysis based on one participant’s experience with breast cancer and associated treatments. A semi-structured interview was conducted. The data were analyzed through description of the case, categories, and themes. It also included categorical aggregation in efforts to seek a collection of instances from the data to explore any issue-relevant meanings. Results: Following data analysis, one overarching theme, return to normalcy, was identified with three subthemes: (a) prioritization of meaningful activities, (b) modifications to activities or routines, (c) lack of referral for immediate needs. Conclusion: Personal knowledge of occupational therapy practice provided support for enhancing engagement in daily meaningful occupations. Lessons learned from this experience could be applied to clients experiencing cancer related side effects to improve engagement in daily occupations

Bridging the Clinic-Home Divide in Muscular Rehabilitation

Musculoskeletal disorders (MSDs) are a major worldwide problem that regularly affects up to a third of the general population. In the US alone, the market for physical therapy was valued at ~32 B USD in 2015, recently growing at ~6% YoY. Besides the direct impact in the quality of life and cost of treatment, MSDs accounted for one-third of days lost due to work-related ill health and injury in countries such as the US, UK and Finland, with ~20% of leaves of absence due to MSD injuries being above a 1-month period. To help mitigate these issues, in this chapter, we describe a novel biofeedback system designed to support part of the rehabilitation processes at home, further extending the state of the art with an app-driven and cloud-based approach. This approach enables the therapists to remotely monitor the progress of the patients and near instant adjustment of the training program from the clinic. The system consists of low-cost wearable devices for electromyography (EMG), a set of user-friendly smartphone apps, and a cloud-based service that allows the patient to have a remote evaluation of his/her performance, handled by the clinical therapist that prescribed the treatment

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

Translation of evidence-based Assistive Technologies into stroke rehabilitation: Users' perceptions of the barriers and opportunities

Background: Assistive Technologies (ATs), defined as "electrical or mechanical devices designed to help people recover movement", demonstrate clinical benefits in upper limb stroke rehabilitation; however translation into clinical practice is poor. Uptake is dependent on a complex relationship between all stakeholders. Our aim was to understand patients', carers' (P&Cs) and healthcare professionals' (HCPs) experience and views of upper limb rehabilitation and ATs, to identify barriers and opportunities critical to the effective translation of ATs into clinical practice. This work was conducted in the UK, which has a state funded healthcare system, but the findings have relevance to all healthcare systems. Methods. Two structurally comparable questionnaires, one for P&Cs and one for HCPs, were designed, piloted and completed anonymously. Wide distribution of the questionnaires provided data from HCPs with experience of stroke rehabilitation and P&Cs who had experience of stroke. Questionnaires were designed based on themes identified from four focus groups held with HCPs and P&Cs and piloted with a sample of HCPs (N = 24) and P&Cs (N = 8). Eight of whom (four HCPs and four P&Cs) had been involved in the development. Results: 292 HCPs and 123 P&Cs questionnaires were analysed. 120 (41%) of HCP and 79 (64%) of P&C respondents had never used ATs. Most views were common to both groups, citing lack of information and access to ATs as the main reasons for not using them. Both HCPs (N = 53 [34%]) and P&C (N = 21 [47%]) cited Functional Electrical Stimulation (FES) as the most frequently used AT. Research evidence was rated by HCPs as the most important factor in the design of an ideal technology, yet ATs they used or prescribed were not supported by research evidence. P&Cs rated ease of set-up and comfort more highly. Conclusion: Key barriers to translation of ATs into clinical practice are lack of knowledge, education, awareness and access. Perceptions about arm rehabilitation post-stroke are similar between HCPs and P&Cs. Based on our findings, improvements in AT design, pragmatic clinical evaluation, better knowledge and awareness and improvement in provision of services will contribute to better and cost-effective upper limb stroke rehabilitation. © 2014 Hughes et al.; licensee BioMed Central Ltd

The Home Program Adherence Tackle Box: A Fishing-Themed Toolkit for Rehabilitation Clinicians

Background: Home programs (HPs) are an important part of the rehabilitation experience and are regularly recommended by occupational therapy practitioners (OTPs) and other rehabilitation clinicians for continuation and supplementation of care, to address a client’s continual needs at home and in the community (DeForge et al., 2008; Donoso Brown, & Fichter, 2017; Emmerson et al., 2017; Picha, & Howell, 2018; Proffitt, 2016). Home programs created by rehabilitation professionals for clients typically include therapeutic exercises, activities, and lifestyle behavior modifications to compliment treatment and/or discharge recommendations. Issuing home programs is an established standard of care to help clients meet targeted client goals and outcomes (Proffitt, 2016). The data in the literature suggests that rates of adherence to rehabilitation home programs are lower than acceptable ranging from 40-70% across various populations (DeForge et al., 2008; Donoso Brown, & Fichter, 2017; Emmerson et al., 2017; Picha, & Howell, 2018; Proffitt, 2016). According to the World Health Organization (2003), adherence is considered a key factor influencing treatment effectiveness and optimal client outcomes, especially when considering lifestyle interventions. Adherence is a complex and multifactorial issue, which may explain why it goes largely unaddressed by practitioners due to the many associated barriers of healthcare systems, providers, and clients (WHO, 2016). Currently, literature is limited regarding occupational therapy’s role in assessing and addressing barriers to home program adherence. Purpose: The purpose of this scholarly project was to develop a user-friendly guide and toolkit designed for rehabilitation practitioners to therapeutically “tackle” the complex, multifactorial challenges and barriers associated with a client’s adherence to HPs, many of which are potentially modifiable with targeted interventions (Picha, & Howell, 2018). Methods: The contributing developers of this product conducted an extensive literature review to determine: (1) current use and prescription of HPs in rehabilitation; (2) barriers and facilitators of adherence to HPs; (3) current use of adherence tools used in rehabilitation; and (4) best practice principles for promoting adherence for HPs. Conclusion: The results of the literature review guided the development of the product, the Home Program Adherence Tackle Box. The Home Program Adherence Tackle Box contains client centered strategies and critical guiding resources that OTPs, and other clinical rehabilitation enthusiasts, can use to skillfully facilitate client adherence to home program recommendations to enhance one\u27s function and occupations in life. This themed booklet includes evidence-based strategies and intervention resources to help efficiently guide rehabilitation professionals in holistically promoting HP adherence. It includes the development, collection, and organization of a multitude of relevant tackle tools