Tele-rehabilitation: present and future

telerehab.es

Rehabilitation robotics and technologies have found acceptance in most of the top level national rehabilitation centers in Europe, United States and Canada, as well as in countries of the Far East. These systems present a technological complexity that requires constant maintenance and highly qualified operators. On the other hand research results indicate that successful rehabilitation requires more involvement and time of the impaired subjects than the duration of their hospitalization. Outpatient treatments and the continuation of the therapy in local and smaller rehabilitation facilities and at home should follow the clinical rehabilitation. Current challenges are the implementation of affordable rehabilitation systems for outpatient centers and the development of low-cost solutions for domestic environments. The research effort in TeleREHA, a nationally financed research project of four leading technological centers, is devoted to improving knowledge in the practice of in-home motor and cognitive rehabilitation, especially from impairments resulting from stroke. Stroke is a leading cause of deficits in the ageing population resulting in long-term impairment and disability. As a method of treating these deficits, the efficacy of robot-mediated therapy has proven comparable to conventional treatment in terms of outcome measures, and has the added advantage of low-cost scalability for addressing higher throughput demands. With an initial focus toward the Spanish health care system, it is considered that the introduction of low-cost in-home devices is the optimal pathway to maximizing benefit and availability to the patient, while simultaneously minimizing longterm care costs to the system. The objective of TeleREHA is to generate the necessary knowledge of the rehabilitation process for motor and cognitive impairments as it pertains to robot-mediated therapy and tele-rehabilitation technologies.

Lecture Notes in Computer Science, 2015

The lack of success of tele-monitoring systems in non-clinical environments is mainly due to the difficulty experienced by common users to deal with them. In particular, for achieving a correct operation, the user is required to take care of a number of annoying details, such as wearing them correctly, putting them in operation, using them in a proper way, and transferring the acquired data to the medical center. In spite of the many technological advances concerning miniaturization, energy consumption reduction, and the availability of mobile devices, many things are still missing to make these technologies simple enough to be really usable by a broad population, and in particular by elderly people. To bridge this gap between users and devices, a smart software layer could automatically manage configuration, calibration, and data transfer without requiring the intervention of a formal caregiver. This paper describes the key features that should be implemented to simplify the needed initial calibration phase of sensing systems and to support the patient with a multimodal feedback throughout the execution of the exercises. A simple mobile application is also presented as a demonstrator of the advantages of the proposed solution.

International Journal on Disability and Human Development, 2014

Tele-rehabilitation refers to the use of information and communication technologies to provide rehabilitation services to people in their homes or other environments. The objective of this paper is to present the development, validation and usability testing of a low-cost, markerless full body tracking virtual reality system designed to provide remote rehabilitation of the upper extremity in patients who have had a stroke. The Methods and Results sections present the progress of our work on system development, system validations and a feasibility/usability study. We conclude with a brief summary of the initial stages of an intervention study and a discussion of our findings in the context of the next steps. The validation study demonstrated considerable accuracy for some outcomes (i.e., shoulder "pitch" angle, elbow flexion, trunk forward and side-to-side deviation). In addition positive responses were received from the clients who participated in the feasibility study. We are currently at the process of improving the accuracy of the system as well as conducting a randomized clinical trial to assess the effectiveness of the system to improve upper extremity function post-stroke.

The Journal of Rehabilitation Research and Development, 2006

Our ability to provide in-home rehabilitation is limited by distance and available personnel. We may be able to meet some rehabilitation needs with videoconferencing technology. This article describes the feasibility of teletechnology for delivering multifactorial, in-home rehabilitation interventions to community-dwelling adults recently prescribed a mobility aid. We used standard telephone lines to provide twoway video and audio interaction. The interventions included prescription of and/or training in functionally based exercises, home-hazard assessment, assistive technology, environmental modifications, and adaptive strategies. Patients were evaluated in three transfer and three mobility tasks, and appropriate treatment was provided over the course of four visits. To date, 13 of the 14 subjects enrolled in the rehabilitation study have completed all four visits (56 visits total). Equipment-related problems were most common early in the study, particularly on the initial visit to a subject's house.We identified (mean ± standard deviation [SD]) 13.1 ± 7.9 mobility/self-care problems per subject and made 12.5 ± 8.3 recommendations per subject to address those problems. At 6-week follow-up, 60.1 percent of our recommendations had been implemented. The greatest number of problems was identified for tub transfers (mean ± SD = 3.4 ± 1.4), the greatest number of recommendations was made for toilet transfers (mean ± SD = 3.1 ± 3.4), and the most frequently implemented recommendations were for transition between locations. Overall, our results show promise that both the telerehabilitation technology and intervention procedures are feasible.

Journal of Telemedicine and Telecare, 2008

Computer Methods in Biomechanics and Biomedical Engineering: Imaging & Visualization, 2020

Advances in informatics technologies have enabled new ways of attention in a health-care system. This kind of approach is commonly referred as a telemedicine. In this context, this work proposes an environment that facilitates the execution of a specific protocol of physical rehabilitation on a patient by a health care specialist through tele-operating technical aids. For this purpose, a service-oriented architecture was designed and implemented. In addition, considering the dynamics of the system oriented to occurrence of discrete events, formal modelling tool known as Coloured Petri Nets were used for validation and verification. Finally, numerous rehabilitation protocols were tested without presenting alterations with respect to the technical model.

Arabian Journal for Science and Engineering

The world is witnessing interesting challenges in several fields, including medicine. Solutions to many of these challenges are being developed in the field of artificial intelligence. As a result, artificial intelligence techniques can be used in telerehabilitation to facilitate the work of doctors and to find methods that can be used to better treat methods that can be used to better treat patients. Motion rehabilitation is an essential procedure for elderly people and patients undergoing physiotherapy after physical procedures such as surgery for the anterior cruciate ligament (ACL), a frozen shoulder. To regain normal motion, the patient must participate in rehabilitation sessions. Furthermore, telerehabilitation has become a significant trend in research studies because of the COVID-19 pandemic, which is continuing to affect the world through the delta and the omicron variants, and other epidemics. In addition, because of other special issues like the vastness of the desert area in Algeria and the lack of facilities, it is ideal to avoid requiring patients to travel for all of their rehabilitation sessions; patients should be able to perform their rehabilitation exercises at home. Thus, telerehabilitation could lead to promising developments in this field. Therefore, our project's goal is to develop a website for telerehabilitation that can be used to facilitate rehabilitation from a distance. We also want to track the progress of patients' range of motion (ROM) in real time using artificial intelligence techniques, by controlling the angles of the motion of a limbs about a joint.

Proceedings of The IEEE, 2001

The potential of modern telecommunications and computing technologies as tools in the delivery and evaluation of assistive technology (AT) has been discussed and has been termed telerehabilitation. The problems of providing AT in rural areas parallels the delivery of health care to rural areas where the proportion of people with chronic illnesses is higher and the means to pay for them is reduced. Large distances mean long travel times, increasing costs associated with any service delivery, and consuming valuable time skilled professionals could be using to provide services elsewhere. The technology available for practising telerehabilitation is significant and expanding at a rapid rate. Currently, plain old telephone systems (POTS) and broad-band videoconferencing equipment, Internet and World Wide Web, and embedded processor systems are most widely available. These technologies continue to evolve as well as emerging technologies such as wearable sensors that will have telehabilitation applications. Issues of payment, safety liability, and licensure need to be resolved, as legislation lags the development of new technologies

IEEE Access, 2019

In recent years, the software applications for medical assistance, including the telerehabilitation, have known a high and a continuous presence in the medical area. The ePHoRt is a Web-based platform for the remote home monitoring rehabilitation exercises in patients after hip replacement surgery. It involves a learning phase and a serious game scheme for the execution and evaluation of the exercises as part of a therapeutic program. Modular software architecture is proposed, under the patient perspective, to be used as a reference model for researchers or professionals who wish to carry out tele-rehabilitation platforms, and to guarantee security, flexibility, and scalability. The architecture incorporates two main components. The first one manages the patient' therapeutic programs taking into account two principles: 1) maintain loose coupling between the layers of the framework and 2) Don't Repeat Yourself (DRY). The second one evaluates the performed exercises in real time considering an independent acquisition mechanism for the patient movements and two artificial algorithms. The first algorithm allows evaluating the quality of the movements, while the second one allows assessing the levels of pain intensity by recognizing the patient' emotions when performing the movements. Details of the components and the meta-model of the architecture are presented and discussed considering their advantages and disadvantages.

ACM Transactions on Cyber-Physical Systems, 2018

The adoption of motor-rehabilitative therapies is highly demanded in a society where the average age of the population is constantly increasing. A recent trend to contain costs while providing high quality of healthcare services is to foster the adoption of self-care procedures, performed primarily in patients’ environments rather than in hospitals or healthcare structures, especially in the case of intensive and chronic patients’ rehabilitation. This work presents a platform to enhance limb functional recovery through telerehabilitation sessions. It relies on a sensing system based on inertial sensors and data fusion algorithms, a module to provide bio-feedback tailored to the users, and a module dedicated to the physicians’ practices. The system design had to face several cyber-physical challenges due to the tight interaction between patient and sensors. For instance, integrating the body kinematics into the sensory processing improved the precision of measurements, simplified the...