Strengthening education in rehabilitation: Assessment technology and digitalization

Rehabilitation is a discipline increasingly growing around the world due to several reasons, but probably the most important one is aging population and chronicity. A need to harmonize education has been identified, and although several International organizations such as the European Union of Medical Specialists (UEMS) and the International Society of Physical Medicine and Rehabilitation (ISPRM) have defined standards, given the quick growth of new evidence and assessment methods an urge to establish new ones arises. Functional assessment and tools used to do so are key in rehabilitation processes. This comprises self-reported questionnaires, conventional clinical evaluation but more notably high technology assessment methods, such as movement analysis systems, posturography, different types of dynamometers and kinesiologic electromyography among others. More recently, a wide range of wearable systems has been introduced in patient assessment. This is generating many published protocols as well as reliability and validity studies. The objective of this narrative review is to present main assessment technologies relevant to rehabilitation, its situation of this specific area in pre-graduate and post-graduate rehabilitation educational programs, and to elaborate a formative proposal including technological foundations of assessment and also highlighting the importance of solid reliability and validity of assessment methods comprehension. The main objective of this proposal is to provide basic knowledge about rehabilitation and methodologies for outcomes evaluation, including new technologies, to all health professionals, but especially to those who work or will work in the field of Rehabilitation

Outcomes measurement in rehabilitation. Key training need in the 21st century

Herrera-Ligero, C.; Bermejo Bosch, I.; Chaler Vilaseca, J. (2022). La medida de resultados en rehabilitación. Necesidad formativa clave en el siglo XXI. Rehabilitación. 56(3):169-172. https://doi.org/10.1016/j.rh.2022.02.00716917256

Strengthening education in rehabilitation: Assessment technology and digitalization

Rehabilitation is a discipline increasingly growing around the world due to several reasons, but probably the most important one is aging population and chronicity. A need to harmonize education has been identified, and although several International organizations such as the European Union of Medical Specialists (UEMS) and the International Society of Physical Medicine and Rehabilitation (ISPRM) have defined standards, given the quick growth of new evidence and assessment methods an urge to establish new ones arises. Functional assessment and tools used to do so are key in rehabilitation processes. This comprises self-reported questionnaires, conventional clinical evaluation but more notably high technology assessment methods, such as movement analysis systems, posturography, different types of dynamometers and kinesiologic electromyography among others. More recently, a wide range of wearable systems has been introduced in patient assessment. This is generating many published protocols as well as reliability and validity studies. The objective of this narrative review is to present main assessment technologies relevant to rehabilitation, its situation of this specific area in pre-graduate and post-graduate rehabilitation educational programs, and to elaborate a formative proposal including technological foundations of assessment and also highlighting the importance of solid reliability and validity of assessment methods comprehension. The main objective of this proposal is to provide basic knowledge about rehabilitation and methodologies for outcomes evaluation, including new technologies, to all health professionals, but especially to those who work or will work in the field of Rehabilitation

FallSkip: aportaciones al ámbito clínico

[ES] El Instituto de Biomecánica (IBV), en línea con su filosofía de promoción y transferencia de conocimiento y tecnología, desarrolla en 2017 la aplicación para valoración del riesgo de caída FallSkip/IBV. Esta herramienta responde a una demanda sociosanitaria explícita debida a la elevada prevalencia de las caídas en las personas de edad avanzada y a los costes asociados a ellas. FallSkip permite, en menos de dos minutos, realizar una prueba de valoración completa y obtener resultados sobre marcha, equilibrio, sentarse y levantarse y tiempo de reacción, así como un índice de riesgo de caída final de manera instantánea. Su validez y fiabilidad ha sido probada en varios contextos clínicos, incluyendo pacientes con Enfermedad de Alzheimer o Parkinson. La objetividad de los resultados proporcionados, así como su versatilidad y agilidad, convierten a FallSkip en una herramienta muy útil en procesos asistenciales de diferente tipo, donde la calidad en la atención es primordial, pero también lo son la eficiencia y la rapidez. Destacan, entre otros usos clínicos actuales, su empleo en programas de prevención de caídas en población de edad avanzada dentro de la Atención Primaria, o el uso dentro de Servicios de Medicina Física y Rehabilitación, a nivel tanto asistencial como investigador. Sobre estos últimos, los facultativos involucrados destacan su sencillez, objetividad y su utilidad en la objetivación de la evolución funcional y el diseño de tratamientos específicos.Apoyo del IVACE (Instituto Valenciano de Competitividad Empresarial) a las actividades del IBV en este ámbito, tal y como se desprende de la financiación recibida en el marco del Proyecto (IMAMCJ/2021/1), en la Línea Nominativa S8021000 distribuida a favor de los centros tecnológicos de la Comunitat Valenciana, aprobada por la Ley de Presupuestos de la Generalitat para 2021.Herrera-Ligero, C.; Ruíz García, A.; Garrido Jaen, JD.; Bermejo Bosch, I.; Andrade Celdrán, J.; Porcar Seder, R. (2021). FallSkip: aportaciones al ámbito clínico. Revista de Biomecánica (Online). (68):1-7. http://hdl.handle.net/10251/187294176

NedCodo/IBV, haciendo fácil y objetiva la valoración biomecánica del codo

[ES] NedCodo/IBV es una aplicación software desarrollada por el Instituto de Biomecánica (IBV) para asistir al profesional en la evaluación funcional del codo, destacando su utilidad en el estudio de patologías complejas como la epicondilosis o epicondilitis lateral. Se trata de un producto sanitario Clase I, especialmente diseñado para ofrecer resultados objetivos y no manipulables de la función del codo de una forma ágil y sencilla. Los resultados se comparan con bases de datos para facilitar la interpretación y toma de decisiones relacionadas con el manejo terapéutico y la reintegración laboralHerrera-Ligero, C.; Medina Ripoll, E.; Martínez-Iranzo, U.; Pitarch Corresa, S.; Bermejo Bosch, I.; Andrade Celdrán, J.; Lopez Pascual, J. (2020). NedCodo/IBV, haciendo fácil y objetiva la valoración biomecánica del codo. Revista de Biomecánica (Online). (67):1-7. http://hdl.handle.net/10251/176119S176

Kinescan/IBV V11: Biomechanical assessment in real time

[EN] Experts in biomechanical assessment are very interested in increasing precision of the measurements, reducing the needed time for evaluating patients and giving more flexibility to their labs. Therefore, we developed a new version of our system for kinematic analysis of human movement: Kinescan/IBV V11. Kinescan/IBV V11 is based in digital video technology and is able to make a distributed pre-processing. So it can analyse automatically movements in real time and use an unlimited number of cameras. The labs of functional assessment can reduce their costs, reduce their needed time for the assessment and increase their precision and reliability.[ES] El interés de los expertos en valoración biomecánica por incrementar la precisión de las medidas, reducir los tiempos de valoración y dotar de mayor flexibilidad a sus laboratorios es cada vez más creciente. Por esos motivos, hemos desarrollado una nueva versión de nuestro sistema de análisis cinemático de los movimientos humanos: Kinescan/IBV V11. Kinescan V11 es un sistema basado en tecnología vídeo digital con preprocesado distribuido que permite, entre otras características, analizar los movimientos en tiempo real y de forma automática y utilizar cuantas cámaras sean necesarias. Gracias a esta tecnología, los laboratorios de valoración funcional del IBV podrán reducir sus costes de operación, reducir los tiempos de valoración e incrementar su precisión y fiabilidad.Montero Vilela, J.; Parra Gonzalez, F.; Parrilla Bernabé, E.; Medina Ripoll, E.; Lopez Pascual, J.; Moreno Cano, R.; Castelli., A.... (2013). Kinescan/IBV v11: Valoración biomecánica en tiempo real. Revista de biomecánica. 59:35-38. http://hdl.handle.net/10251/38676S35385

Utilidad clínica de NedAMHPlus/IBV en la valoración de la marcha. A propósito de un caso

[ES] NedAMHPlus/IBV es una aplicación software diseñada por el Instituto de Biomecánica (IBV) para ayudar al profesional clínico a realizar un análisis objetivo de la marcha de una forma sencilla, rápida y, lo que es fundamental, fácilmente interpretable ya que se centra en detectar y cuantificar los principales déficits dinámicos y cinemáticos de la misma. A través de un caso clínico se muestra la utilidad de esta aplicación en el proceso de interpretación y decisión terapéutica guiado por los resultados obtenidos con esta prueba.Peydro De Moya, MF.; Bermejo Bosch, I.; Herrera-Ligero, C.; Medina Ripoll, E.; Guerrero Ramos, D.; Andrade Celdrán, J.; Lopez Pascual, J. (2021). Utilidad clínica de NedAMHPlus/IBV en la valoración de la marcha. A propósito de un caso. Revista de Biomecánica (Online). (68):1-6. http://hdl.handle.net/10251/187405166

Rehabilitation of gait after stroke: a review towards a top-down approach

This document provides a review of the techniques and therapies used in gait rehabilitation after stroke. It also examines the possible benefits of including assistive robotic devices and brain-computer interfaces in this field, according to a top-down approach, in which rehabilitation is driven by neural plasticity

Functional principal component analysis as a new methodology for the analysis of the impact of two rehabilitation protocols in functional recovery after stroke

[EN] Background: This study addressed the problem of evaluating the effectiveness of two protocols of physiotherapy for functional recovery after stroke. In particular, the study explored the use of Functional Principal Component Analysis (FPCA), a multivariate data analysis in order to assess and clarify the process of regaining independence after stroke. Methods: A randomized double-blind controlled trial was performed. Thirteen subjects with residual hemiparesis after a single stroke episode were measured in both in- and outpatient settings at a district hospital. All subjects were able to walk before suffering the stroke and were hemodynamically stable within the first week after stroke. Control and target groups were treated with conventional physiotherapy for stroke, but specific techniques were added for treatment of the target group depending on patients' functional levels. Independence level was assessed with the Barthel Index (BI) throughout 7 evolution stages (hemodynamic stability, beginning of standing, beginning of physical therapy sessions in the physiotherapy ward and monthly assessment for 6 months after stroke). Results: FPCA was applied for data analysis. Statistically significant differences were found in the dynamics of the recovery process between the two physiotherapy protocols. The target group showed a trend of improvement six months after stroke that was not present in the control group. Conclusions: FPCA is a method which may be used to provide greater insight into the analysis of the rehabilitation process than that provided by conventional parametric methods. So, by using the whole curves as basic data parameters, subtle differences in the rehabilitation process can be found. FPCA represents a future aid for the fine analysis of similar physiotherapy techniques, when applied in subjects with a huge variability of functional recovery, as in the case of post-stroke patients.This contribution has been carried out with financial support from the European Commission within the Seventh Framework Programme under contract FP7-ICT-2009-247935: BETTER BNCI-dr. The authors wish to thank the Stroke Rehabilitation Team of Hospital Universitari i Politecnic La Fe (Valencia, Spain), specially Dr. M.R. Beseler, physiotherapist M. Matas and physiotherapist A. Estaun. We also gratefully acknowledge patients who have participated in this study with great enthusiasm.Sánchez-Sánchez, M.; Belda Lois, JM.; Mena Del Horno, S.; Viosca Herrero, E.; Gisbert-Morant, B.; Igual-Camacho, C.; Bermejo Bosch, I. (2014). Functional principal component analysis as a new methodology for the analysis of the impact of two rehabilitation protocols in functional recovery after stroke. Journal of NeuroEngineering and Rehabilitation. 11:1-9. https://doi.org/10.1186/1743-0003-11-134S191

Orthosis to reduce essential tremor

[EN] The Institute of Biomechanics (IBV) coordinated the technical development of an orthesis to reduce essential tremor. The Valencian company EMO coordinated this European project called TREMEND. Furthermore, the companies Cultraro and OKO Solution, the research centre ISRI and the Neurology Service of Hospital General Universitario de Valencia collaborated in this project. The results show that the orthosis is effective and it reduces essential tremor in the wrist about 30 %, allowing affected people increase their degree of independence.[ES] El Instituto de Biomecánica (IBV) ha coordinado técnicamente el desarrollo de una ortesis de muñeca para reducir el temblor esencial. Esta iniciativa se enmarca dentro del proyecto europeo TREMEND, cuyo coordinador ha sido la empresa valenciana EMO. En el proyecto han participado las empresas Cultraro y OKO Solution, además del centro tecnológico ISRI y el Servicio de Neurología del Hospital General Universitario de Valencia. Los resultados muestran que la ortesis es efectiva y reduce el temblor esencial en la muñeca más de un 30%, permitiendo a los afectados aumentar su grado de independencia.TREMEND (Nº de contrato: 262127) es un Proyecto de Investigación en Beneficio de las PYMES cofinanciado por la Comisión Europea a través del VII Programa Marco.Belda Lois, JM.; Prieto Gil, L.; Bermejo Bosch, I.; Fernández Barrachina, P.; Fernández Barrachina, L.; Castillo Ruiz, A.; Gargallo Rico, E.... (2013). Ortesis para reducir el temblor esencial. Revista de biomecánica. 60:35-38. http://hdl.handle.net/10251/38525S35386