Wearable Technology Supported Home Rehabilitation Services in Rural Areas:– Emphasis on Monitoring Structures and Activities of Functional Capacity Handbook

The sustainability of modern healthcare systems is under threat. – the ageing of the population, the prevalence of chronic disease and a need to focus on wellness and preventative health management, in parallel with the treatment of disease, pose significant social and economic challenges. The current economic situation has made these issues more acute. Across Europe, healthcare expenditure is expected to rice to almost 16% of GDP by 2020. (OECD Health Statistics 2018). Coupled with a shortage of qualified personnel, European nations are facing increasing challenges in their ability to provide better-integrated and sustainable health and social services. The focus is currently shifting from treatment in a care center to prevention and health promotion outside the care institute. Improvements in technology offers one solution to innovate health care and meet demand at a low cost. New technology has the potential to decrease the need for hospitals and health stations (Lankila et al., 2016. In the future the use of new technologies – including health technologies, sensor technologies, digital media, mobile technology etc. - and digital services will dramatically increase interaction between healthcare personnel and customers (Deloitte Center for Health Solutions, 2015a; Deloitte Center for Health Solutions 2015b). Introduction of technology is expected to drive a change in healthcare delivery models and the relationship between patients and healthcare providers. Applications of wearable sensors are the most promising technology to aid health and social care providers deliver safe, more efficient and cost-effective care as well as improving people’s ability to self-manage their health and wellbeing, alert healthcare professionals to changes in their condition and support adherence to prescribed interventions. (Tedesco et al., 2017; Majumder et al., 2017). While it is true that wearable technology can change how healthcare is monitored and delivered, it is necessary to consider a few things when working towards the successful implementation of this new shift in health care. It raises challenges for the healthcare systems in how to implement these new technologies, and how the growing amount of information in clinical practice, integrates into the clinical workflows of healthcare providers. Future challenges for healthcare include how to use the developing technology in a way that will bring added value to healthcare professionals, healthcare organizations and patients without increasing the workload and cost of the healthcare services. For wearable technology developers, the challenge will be to develop solutions that can be easily integrated and used by healthcare professionals considering the existing constraints. This handbook summarizes key findings from clinical and laboratory-controlled demonstrator trials regarding wearables to assist rehabilitation professionals, who are planning the use of wearable sensors in rehabilitation processes. The handbook can also be used by those developing wearable sensor systems for clinical work and especially for use in hometype environments with specific emphasis on elderly patients, who are our major health care consumers

Kehityksen ja oppimisen tuki sekä inklusiivisuus varhaiskasvatuksessa : Selvitys nykytilasta kunnallisissa ja yksityisissä varhaiskasvatuspalveluissa sekä esitys kehityksen ja oppimisen tuen malliksi

Lapsella on varhaiskasvatuslain mukaan oikeus kehityksen ja oppimisen tukeen. Varhaiskasvatusta kehitetään inkluusion periaatteiden mukaisesti, jolloin lähtökohtana tulee olla lapsen osallisuus ja yhteenkuuluvuus. Työryhmä selvitti tuen toteutumista koostamalla selvitys- ja tutkimustietoa, toteuttamalla valtakunnallisen kyselyn sekä järjestämällä varhaiskasvatuksen järjestäjille ja vanhemmille pienryhmäkeskusteluja. Selvityksen pohjalta annetaan ehdotus tuen mallista, jossa kuvataan kaikille lapsille tarjottavan tuen, tuen tehostamisen sekä erityisen tuen periaatteet, muodot ja rakenteet. Selvityksen mukaan inkluusion käsite on varhaiskasvatuksen ammattilaisille epäselvä ja sitä kuvataan tuen järjestämisen paikan kautta. Kehityksen ja oppimisen tuen saatavuuden ja toteutumisen vaihtelu asettaa lapset eriarvoiseen asemaan. Tuen vaihtelevuus ja toteutumattomuus korostuvat yksityisessä varhaiskasvatuksessa ja perhepäivähoidossa. Lapsen oikeus tukeen sekä pedagogiseen varhaiskasvatukseen nousee haasteeksi erityisesti silloin, kun lapsen tarvitsema tuki on vaativaa. Jatkossa tuen toteutumista tulee yhdenmukaistaa ja lasten asemaa tasa-arvoistaa kirjaamalla lakiin tuen malli, vahvistamalla henkilöstön tukeen liittyvää osaamista sekä kiinnittämällä erityistä huomiota vaativaan tukeen. Inkluusioperiaatetta varhaiskasvatuksen kehittämisessä tulee konkretisoida ja henkilöstön inkluusioon liittyvää ymmärrystä ja osaamista lisätä

Feasibility of Sensor Technology for Balance Assessment in Home Rehabilitation Settings

The increased use of sensor technology has been crucial in releasing the potential for remote rehabilitation. However, it is vital that human factors, that have potential to affect real-world use, are fully considered before sensors are adopted into remote rehabilitation practice. The smart sensor devices for rehabilitation and connected health (SENDoc) project assesses the human factors associated with sensors for remote rehabilitation of elders in the Northern Periphery of Europe. This article conducts a literature review of human factors and puts forward an objective scoring system to evaluate the feasibility of balance assessment technology for adaption into remote rehabilitation settings. The main factors that must be considered are: Deployment constraints, usability, comfort and accuracy. This article shows that improving accuracy, reliability and validity is the main goal of research focusing on developing novel balance assessment technology. However, other aspects of usability related to human factors such as practicality, comfort and ease of use need further consideration by researchers to help advance the technology to a state where it can be applied in remote rehabilitation settings

Remote Rehabilitation: A solution to Overloaded & Scarce Health Care Systems

The population across Northern Europe is aging. Coupled with socio-economic challenges, health care systems are at risk of overloading and incurring unsustainable high costs. Rehabilitation services are used disproportionately by older people. One solution pertinent to rural areas is to change the model of rehabilitation to incorporate new technologies. This has the potential to free resources and reduce costs. However, implementation is challenging. In the Northern Periphery and Artic Programme (NPA), the Smart sensor Devices for rehabilitation and Connected health (SENDoc) project [1] is focused on introducing wearable sensor systems among elderly communities to support their rehabilitation. It is important to understand the context into which change is introduced. Therefore, an overview of the current state of health care systems in the four partner countries is presented, defining the concept of rehabilitation and how remote rehabilitation is currently delivered. Advantages (e.g. enhanced outcomes, less cost and enhanced patient engagement), and disadvantages of remote rehabilitation (e.g. complexity involved in the use of technology, design and safety issues) are discussed. It is concluded that the key advantage of remote rehabilitation is the potential to support change in patient behaviour, empowering active participation and living independently, with less need to travel for face-to-face sessions. Remote rehabilitation can make enhance quality of health care service delivery. However, all relevant stakeholders including medical staff and patients should be included in the design of the technology employed with a focus on simplicity, usability and robustness. Compliance with Security and the new GDPR regulation will be key to supporting remote rehabilitation. In addition, the diversity of available platforms and devices must also be supported to ensure interoperability. Finally, remote rehabilitation needs to be further validated in practice. Attempts to implement and sustain change should be cognisant of local and current organization of health care and of existing enablers and barriers

Factors Influencing Continued Wearable Device Use in Older Adult Populations: Quantitative Study

Background: The increased use of wearable sensor technology has highlighted the potential for remote telehealth services such as rehabilitation. Telehealth services incorporating wearable sensors are most likely to appeal to the older adult population in remote and rural areas, who may struggle with long commutes to clinics. However, the usability of such systems often discourages patients from adopting these services. Objective: This study aimed to understand the usability factors that most influence whether an older adult will decide to continue using a wearable device. Methods: Older adults across 4 different regions (Northern Ireland, Ireland, Sweden, and Finland) wore an activity tracker for 7 days under a free-living environment protocol. In total, 4 surveys were administered, and biometrics were measured by the researchers before the trial began. At the end of the trial period, the researchers administered 2 further surveys to gain insights into the perceived usability of the wearable device. These were the standardized System Usability Scale (SUS) and a custom usability questionnaire designed by the research team. Statistical analyses were performed to identify the key factors that affect participants’ intention to continue using the wearable device in the future. Machine learning classifiers were used to provide an early prediction of the intention to continue using the wearable device. Results: The study was conducted with older adult volunteers (N=65; mean age 70.52, SD 5.65 years) wearing a Xiaomi Mi Band 3 activity tracker for 7 days in a free-living environment. The results from the SUS survey showed no notable difference in perceived system usability regardless of region, sex, or age, eliminating the notion that usability perception differs based on geographical location, sex, or deviation in participants’ age. There was also no statistically significant difference in SUS score between participants who had previously owned a wearable device and those who wore 1 or 2 devices during the trial. The bespoke usability questionnaire determined that the 2 most important factors that influenced an intention to continue device use in an older adult cohort were device comfort (τ=0.34) and whether the device was fit for purpose (τ=0.34). A computational model providing an early identifier of intention to continue device use was developed using these 2 features. Random forest classifiers were shown to provide the highest predictive performance (80% accuracy). After including the top 8 ranked questions from the bespoke questionnaire as features of our model, the accuracy increased to 88%. Conclusions: This study concludes that comfort and accuracy are the 2 main influencing factors in sustaining wearable device use. This study suggests that the reported factors influencing usability are transferable to other wearable sensor systems. Future work will aim to test this hypothesis using the same methodology on a cohort using other wearable technologies

Validation of the wearable sensor system - MoveSole® smart insoles

Biomechanical analysis of gait is commonly used in physiotherapy. Ground reaction forces during phases of gait is one element of kinetic analysis. In this article, we analyze if the MoveSole® smart insole is valid and accurate equipment for measuring ground reaction forces in clinical physiotherapy. MoveSole® StepLab is a mobile measurement system for instant underfoot force measurements during gait. Unique electromagnetic film (EMFI) based sensor technology and printed electronics production technology is integrated in the MoveSole® StepLab measurement system. The MoveSole® StepLab measures plantar ground reaction force distribution over the sensors and provides an estimation of the maximum total ground reaction force. We developed a two phase validation process to extract relevant parameters and compared the results to a Kistler force plate using the BioWare® analyzing program as a reference method. Our results show that MoveSole® smart insoles reach the strong level of accuracy needed in clinical work concerning highest ground reaction forces during step (Pearson correlation .822 - .875). The correlation of the time when the maximum ground reaction force occurred was moderate, e.g. during heel strike or toe-off (Pearson correlation natural gait speed .351 - .462, maximum gait speed .430). Our conclusion is that MoveSole® smart insoles are a potential tool for analyzing and monitoring gait ground reaction forces during physiotherapy processes

Remote rehabilitation: a solution to overloaded & scarce health care systems

The population across Northern Europe is aging. Coupled with socio-economic challenges, health care systems are at risk of overloading and incurring unsustainable high costs. Rehabilitation services are used disproportionately by older people. One solution pertinent to rural areas is to change the model of rehabilitation to incorporate new technologies. This has the potential to free resources and reduce costs. However, implementation is challenging. In the Northern Periphery and Artic Programme (NPA), the Smart sensor Devices for rehabilitation and Connected health (SENDoc) project [1] is focused on introducing wearable sensor systems among elderly communities to support their rehabilitation. It is important to understand the context into which change is introduced. Therefore, an overview of the current state of health care systems in the four partner countries is presented, defining the concept of rehabilitation and how remote rehabilitation is currently delivered. Advantages (e.g. enhanced outcomes, less cost and enhanced patient engagement), and disadvantages of remote rehabilitation (e.g. complexity involved in the use of technology, design and safety issues) are discussed. It is concluded that the key advantage of remote rehabilitation is the potential to support change in patient behaviour, empowering active participation and living independently, with less need to travel for face-to-face sessions. Remote rehabilitation can make enhance quality of health care service delivery. However, all relevant stakeholders including medical staff and patients should be included in the design of the technology employed with a focus on simplicity, usability and robustness. Compliance with Security and the new GDPR regulation will be key to supporting remote rehabilitation. In addition, the diversity of available platforms and devices must also be supported to ensure interoperability. Finally, remote rehabilitation needs to be further validated in practice. Attempts to implement and sustain change should be cognisant of local and current organization of health care and of existing enablers and barriers

Tehtäväilmoitus: Lihasvoimaa ensihoitajille!

Ensihoitajien työ on fyysisesti erittäin kuormittavaa ja sen vuoksi on tärkeää, että ensihoitajilla on hyvä fyysinen suorituskyky. Kuormittavimpia työtehtäviä ensihoitotyössä ovat potilaan kantaminen, siirtäminen ja nostaminen sekä hoitotarvikkeiden kantaminen. Ensihoitajat eivät voi vaikuttaa työnsä fyysiseen kuormittavuuteen, mutta he voivat vaikuttaa omaan fyysiseen suorituskykyynsä. Opinnäytetyömme tulostavoitteena oli tehdä kuntosaliohjelma ensihoitajille. Työ piti sisällään aloittelijan ja edistyneemmän harjoittelijan kuntosaliohjelmat. Kuntosaliohjelman välittömänä tavoitteena oli, että ensihoitajat tutustuvat kuntosaliohjelmaan ja aloittavat kuntosaliharjoittelun. Kuntosaliohjelman keskipitkän aikavälin tavoitteena on se, että ensihoitajat harjoittelevat kuntosalilla progressiivisesti ja säännöllisesti ja ymmärtävät hyvän lihasvoiman merkityksen fyysiseen toimintakykyyn ja sitä kautta myös työkykyyn. Pitkän aikavälin tavoitteena ensihoitajien lihasvoima kasvaa lihaksissa, jotka erityisesti kuormittuvat ensihoitotyön fyysisesti raskaimmissa työtehtävissä. Tätä kautta ensihoitajien fyysinen toimintakyky paranee ja työperäiset vammat ja sairastumiset vähenevät. Aloitimme tuotteen valmistamisen selvittämällä, mitkä ovat ensihoitotyön fyysisesti raskaimmat työtehtävät. Teimme fyysisesti raskaimmista työtehtävistä liikeanalyysit, joissa analysoimme, miten tuki- ja liikuntaelimistö kuormittuu. Sen jälkeen laadimme taulukon, johon on koottu kuntosaliliikkeet, joiden säännöllisellä toteuttamisella voidaan parantaa raskaimmissa työtehtävissä kuormittuvien lihasten lihasvoimaa. Seuraavaksi kokosimme valintaperusteet kuntosaliliikkeille ja näiden valintaperusteiden pohjalta valitsimme kuntosaliohjelman liikkeet, jotka jaoimme kolmijakoiseksi kuntosaliohjelmaksi. Tuotteemme sisältää sekä aloittelijan että edistyneemmän harjoittelijan kuntosaliohjelmat. Teimme kuntosaliohjelmasta kuvakäsikirjoituksen, jossa suunnittelimme sen ulkoasua. Sitä apuna käyttäen valmistimme lopullisen tuotteen Adobe InDesing-taitto-ohjelmalla. Tuotteessa kuntosaliohjelmat ja -liikkeet on esitelty sekä tekstin että kuvien avulla. Tuotteen ulkoasuun panostettiin käyttämällä ulkopuolista valokuvaajaa ja taittajaa. Yhteistyökumppaneina meillä oli Oulun ja Lahden UFS, kuntosali Pro - Am, OSAKO sekä ensihoidon erikoislehti Systole. Kuntosaliohjelma julkaistaan Systolen internetsivuilla pdf-tiedostona, josta sen voi ladata tietokoneelle tai tulostaa. Lisäksi Systolelehden 3/2010 numerossa julkaistaan kirjoittamamme artikkeli aiheesta. Tuotekehitysprojektina tehty kuntosaliohjelma ensihoitajille on siis kaikkien käytettävissä.Paramedics face many physically challenging situations in their everyday work and they cannot avoid those situations. Lifting, moving and carrying patients and equipment is hard work and that is why it is important for paramedics to take care of their physique. The aim of the thesis was to make a gym programme designed especially for paramedics. Separate programmes were made for beginners and for advanced trainers. The purpose of the training programme was to increase the muscle power of the paramedics and decrease their workload and work-related injuries and diseases. At the beginning of the project we determined which were the most physically challenging work tasks for paramedics. Then a movement analysis was made on the basis of these tasks. All possible gym moves were collected to charts and the best moves were chosen. For the visual layout a picture hand script was made and the final layout was designed using the picture hand scrip. The gym movements are shown in the programme in pictures and explained in the text. We used a professional photographer and a layout designer to complete the programme. The programme is published on the Internet and there will be an article in Systole journal about it so the gym programme will be available for all paramedics