Requirements for home-based upper extremity rehabilitation using wearable motion sensors for stroke patients:a user-centred approach

Purpose: Telerehabilitation systems have the potential to enable therapists to monitor and assist stroke patients in achieving high-intensity upper extremity exercise in the home environment. We adopted an iterative user-centred approach, including multiple data sources and meetings with end-users and stakeholders to define the user requirements for home-based upper extremity rehabilitation using wearable motion sensors for subacute stroke patients. Methods: We performed a requirement analysis consisting of the following steps: 1) context &amp; groundwork; 2) eliciting requirements; 3) modelling &amp; analysis; 4) agreeing requirements. During these steps, a pragmatic literature search, interviews and focus groups with stroke patients, physiotherapists and occupational therapists were performed. The results were systematically analysed and prioritised into “must-haves”, “should-haves”, and “could-haves”. Results: We formulated 33 functional requirements: eighteen must-have requirements related to blended care (2), exercise principles (7), exercise delivery (3), exercise evaluation (4), and usability (2); ten should-haves; and five could-haves. Six movement components, including twelve exercises and five combination exercises, are required. For each exercise, appropriate exercise measures were defined. Conclusion: This study provides an overview of functional requirements, required exercises, and required exercise measures for home-based upper extremity rehabilitation using wearable motion sensors for stroke patients, which can be used to develop home-based upper extremity rehabilitation interventions. Moreover, the comprehensive and systematic requirement analysis used in this study can be applied by other researchers and developers when extracting requirements for designing a system or intervention in a medical context.</p

The difference between actual and prescribed weight bearing of total hip patients with a trochanteric osteotomy: long-term vertical force measurements inside and outside the hospital

OBJECTIVE: To determine whether patients load the operated leg at a prescribed weight-bearing target load during postoperative recovery. DESIGN: A descriptive prospective study. SETTING: Orthopedic clinic and patients' homes. PARTICIPANTS: Fifty patients who had undergone total hip arthroplasty (THA) with trochanteric osteotomy. INTERVENTION: Patients were verbally instructed by a physical therapist to perform partial weight bearing at a 10% body weight (BW) target load (n=33) or at a 50% BW target load (n=17). MAIN OUTCOME MEASURES: Mean peak load (%BW) and percentage of patients and mean percentage of steps below, equal to, and above the target load. Weight bearing was measured when patients walked with (condition 1) and without (condition 2) a physical therapist in the hospital and walked at home (condition 3). RESULTS: The mean peak load was significantly higher than the target in the 10% BW group for all 3 conditions (condition 1, 19.2% BW; condition 2, 20.0% BW; condition 3, 26.8% BW). In the 50% BW group, the mean peak load was significantly lower than the target in conditions 1 (28.1% BW) and 2 (32.5% BW). No significant difference in weight bearing was found when walking with or without a physical therapist (change in 10% BW, -0.1% BW; change in 50% BW, -3.17% BW). At home, the mean peak load was significantly larger compared with walking without a physical therapist in the hospital (change in 10% BW, -7.0% BW; change in 50% BW, -11.5% BW). CONCLUSIONS: Partial weight bearing at a specific target load was not achieved by patients with a THA when given verbal instructions. Especially when using a low target load and when walking at home with no supervision of a physical therapist, patients loaded the operated leg higher and more frequently above the target load. Other training methods (eg, biofeedback) have to be evaluated to use as training tools for partial weight bearing at specific target loads

Development and validation of a clinically applicable ARM use monitor for people after stroke

Objective: To develop and validate a clinically applicable and easy-to-use accelerometry-based device to measure arm use in people after stroke; the Ac-tiv8 arm use monitor (Activ8-AUM). Design: Development and validation study. Patients: A total of 25 people at different stages of rehabilitation after stroke were included in this study. Methods: The Activ8-AUM consists of 3 single-sensor Activ8s: one on the unaffected thigh and one on each wrist. Arm use was calculated by combining movement intensity of the arms with data from body posture and movements on the leg sensor. Data were divided into 2 sets: one for determining situation-specific movement intensity thresholds for arm use, and the other to validate the Activ8-AUM using video recordings. Results: Overall agreement between the Activ8-AUM and video recordings was 75%, sensitivity was 73% and specificity was 77%. Agreement between the different categories of arm use ranged from 42% to 93% for the affected arm and from 24% to 82% for the unaffected arm. Conclusion: By combining the movement intensity threshold with body posture and movements, good agreement was reached between the Activ8-AUM and video recordings. This result, together with the easy-to-use configuration, makes the Activ8-AUM a promising device to measure arm use in people after stroke

Household Energy Demand and its Challenges for Forest Management in the Kakamega Area, Western Kenya

researchThe presented study investigated the energy demand of a sample of 201 households adjacent to Kakamega Forest. The aim of the study focused on the evaluation of possible threats to the forest under the scenario that the local population continues to heavily use Kakamega Forest, disregarding the restrictions posed by national law. The data collected serves as a base for an estimate of the potential demand on forest resources and as a resource for developing management strategies. Sooner or later the demand for energy and plant material by an ever increasing population needs to be satisfied, and the only easily available resource is Kakamega Forest, in particular in an environment without industrial and commercial benefits. This study showed that the demand for energy is still very high, and that legal restrictions do not protect forests from over-use and destruction. The current restrictions prevent the population from understanding the need to protect the forest. This results in disinterest in protection efforts, even though there is high interest and efforts in protection of common goods. The early awareness of these conditions could protect natural forests from being destroyed, and help to sustainably manage them

Blending Traditional and Western Medicine: Medicinal Plant Use Among Patients at Clinica Anticona in El Porvenir, Peru

Medicinal plants have been used in Peru for millennia for a variety of uses, but, over the last century, modern technology has deterred the increased growth of this valuable knowledge. The present study attempts to look at a clinic in El Porvenir, on the north coast of Peru to discover what kind of medicines are preferred and the factors determining choices made. Previous studies have shown that medicinal plants still play an important role in treatment. However, the results of our study demonstrate that pharmaceutical medicine plays a larger role when compared to the use of medicinal plants. Thus, while many patients feel pharmaceutical medicine is faster and more effective, there are still a large number of plants that are commonly used by patients. As a result, there is evidence that more research in this area should be done in order to learn what factors determine medical choices and what factors might lead to an increase the use of medicinal plants

Indigenous Use and Ethnopharmacology of Medicinal Plants in Far-west Nepal

researchEthnopharmacological knowledge is common and import among tribal populations but much of the information is empirical at best lacking scientific validation. Despite widespread use of plant resources in traditional medicines, bioassay analysis of very few plant species have been conducted to investigate their medicinal properties, and to ascertain safety and efficacy of traditional remedies. The present study analyses indigenous uses of medicinal plants of far-west Nepal and compares with earlier ayurveda studies, phytochemical assessments and pharmacological actions. A field study was carried out in Baitadi and Darchula districts of far-west Nepal. Group discussions, informal meetings, questionnaire surveys and field observations were employed for primary data collection. Voucher specimens were collected with field notes and codes and deposited at Tribhuvan University Central Herbarium (TUCH), Kathmandu. Only 50% of species surveyed shared common uses with ayurvedic medicine. This implies that these herbal remedies are part of an independent health care system in the Nepal Himalaya, which is indigenous and influenced by ayurveda. The folk uses of some of the species were contradicting to those of ayurveda and phytochemical bioassays. A detailed phytochemical study on those species would be an important line of research