Design and Usability of a Home Telerehabilitation System to Train Hand Recovery Following Stroke

2009 ◽  
Vol 3 (4) ◽  
Author(s):  
William K. Durfee ◽  
Samantha A. Weinstein ◽  
Ela Bhatt ◽  
Ashima Nagpal ◽  
James R. Carey
Keyword(s):  
Stroke Rehabilitation ◽  
Hand Function ◽  
Motor Program ◽  
Ease Of Use ◽  
Cortical Reorganization ◽  
Laptop Computer ◽  
File Server ◽  
Home Based ◽  
Treatment Paradigm ◽  
At Home

Current theories of stroke rehabilitation point toward paradigms of intense concentrated use of the afflicted limb as a means for motor program reorganization and partial function restoration. A home-based system for stroke rehabilitation that trains recovery of hand function by a treatment of concentrated movement was developed and tested. A wearable goniometer measured finger and wrist motions in both hands. An interface box transmitted sensor measurements in real-time to a laptop computer. Stroke patients used joint motion to control the screen cursor in a one-dimensional tracking task for several hours a day over the course of 10–14 days to complete a treatment of 1800 tracking trials. A telemonitoring component enabled a therapist to check in with the patient by video phone to monitor progress, to motivate the patient, and to upload tracking data to a central file server. The system was designed for use at home by patients with no computer skills. The system was placed in the homes of 20 subjects with chronic stroke and impaired finger motion, ranging from 2–305 mi away from the clinic, plus one that was a distance of 1057 miles. Fifteen subjects installed the system at home themselves after instruction in the clinic, while nine required a home visit to install. Three required follow-up visits to fix equipment. A post-treatment telephone survey was conducted to assess ease of use and most responded that the system was easy to use. Functional improvements were seen in the subjects enrolled in the formal treatment study, although the treatment period was too short to trigger cortical reorganization. We conclude that the system is feasible for home use and that tracking training has promise as a treatment paradigm.

scholarly journals Exergaming for Lower Limb Stroke Rehabilitation: A Game Controller for Lower Limb Stroke Rehabilitation

2021 ◽  
Author(s):  
◽  
RuiFeng Yeo
Keyword(s):  
Lower Limb ◽  
Stroke Rehabilitation ◽  
Weight Lifting ◽  
Ease Of Use ◽  
Neural Pathways ◽  
Game Controller ◽  
Research Findings ◽  
The Media ◽  
Task Training ◽  
At Home

<p><b>The success of stroke rehabilitation requires the patient engage in early, long-term high repetitions and intensive treatment. When comparing clinical and literature statistics, it is confirmed that clinical rehabilitation is not achieving required repetitions and intensity for effective rehabilitation of basic motor skills as prescribed in physiotherapy literature. It is then the patient’s responsibility to carry out the rehabilitation at home without supervision. These exercises can also be very mundane and repetitive, which reduces the patient’s motivation to exercise. Exergames have been found (Alankus et al., 2010, p. 21130, (King, Hijmans, Sampson, Satherley, & Hale, 2012 Deutsch et al., 2009), (Mortazavi et al., 2014), (Shirzad et al., 2015).to improve patients’ engagement with their therapies at home.</b></p> <p>Currently there are systems to facilitate lower limb stroke rehabilitation,but none includes Strength for Task Training (STT). STT is a novel physiotherapeutic method for lower limb rehabilitation and comprises of two main phases: first being the strength training (priming) and second being the task training. Priming is brief weight lifting to excite the neural pathways (neuroplasticity) in the affected region, which primes the brain for learning; this is then promptly followed by task training to maximise gains in the locomotor ability.</p> <p>This project builds up on the research and development of a game controller by Duncan (2016) for lower limb stroke rehabilitation to facilitate STT. This project is a collaboration with Regan Petrie who designed the media aspect of the exergame system.</p> <p>A game controller was developed and this was part of a complete exergaming system which was designed to specifically facilitate STT. This project compiles more research findings together with feedback from the user and the clinicians to help improve the system. This was to ensure that the design is aligned to the specific requirements of functional STT rehabilitation and contextual needs of the patient.</p> <p>The final output is a pair of prototype shoes which included a sensor to measure movement, a pair of weighted sleeve and a pair of balance sole. The weighted sleeve has removable weights and facilitates the strength part of the training. The shoes are the adaptors which allow the user to the balance soles which is used to constantly challenge the user’s balance. The sensors translate limb movement and are for the user to interact with the game. This system provides a simple and safe method to engage in unsupervised STT.</p> <p>Feedback from clinicians indicates that the shoes can facilitate the strength part of the exercise, the sensors the task part of the training, and the balance sole is useful for challenging and improving balance. User testing sessions offer information about: the usability of the system, including ease of use and intuitive design; the aesthetics of the physical objects and whether the system is engaging patients in their therapies.</p>

scholarly journals Professionals' Views and Experiences of Using Rehabilitation Robotics With Stroke Survivors: A Mixed Methods Survey

2021 ◽  
Vol 3 ◽  
Author(s):  
Lutong Li ◽  
Sarah Tyson ◽  
Andrew Weightman
Keyword(s):  
Stroke Rehabilitation ◽  
Rehabilitation Robotics ◽  
Ease Of Use ◽  
Online Questionnaire ◽  
Patient Factors ◽  
Rehabilitation Robots ◽  
Home Based ◽  
Functional Software ◽  
And Storage ◽  
Staff Workload

Objective: To understand the reason for low implementation of clinical and home-based rehabilitation robots and their potential.Design: Online questionnaire (November 2020 and February 2021).Subjects: A total of 100 professionals in stroke rehabilitation area were involved (Physiotherapists n = 62, Occupation therapists n = 35).Interventions: Not applicable.Main Measures: Descriptive statistics and thematic content analysis were used to analyze the responses: 1. Participants' details, 2. Professionals' views and experience of using clinical rehabilitation robots, 3. Professionals' expectation and concerns of using home-based rehabilitation robots.Results: Of 100 responses, 37 had experience of rehabilitation robots. Professionals reported that patients enjoyed using them and they increased accessibility, autonomy, and convenience especially when used at home. The main emergent themes were: “aims and objectives for rehabilitation robotics,” “requirements” (functional, software, and safety), “cost,” “patient factors” (contraindications, cautions, and concerns), and “staff issues” (concerns and benefits). The main benefits of rehabilitation robots were that they provided greater choice for therapy, increased the amount/intensity of treatment, and greater motivation to practice. Professionals perceived logistical issues (ease of use, transport, and storage), cost and limited adaptability to patients' needs to be significant barriers to tier use, whilst acknowledging they can reduce staff workload to a certain extent.Conclusion: The main reported benefit of rehabilitation robots were they increased the amount of therapy and practice after stroke. Ease of use and adaptability are the key requirements. High cost and staffing resources were the main barriers.

Effects of training with a passive hand orthosis and games at home in chronic stroke: a pilot randomised controlled trial

2016 ◽  
Vol 31 (2) ◽  
pp. 207-216 ◽  
Author(s):  
Sharon M Nijenhuis ◽  
Gerdienke B Prange-Lasonder ◽  
Arno HA Stienen ◽  
Johan S Rietman ◽  
Jaap H Buurke
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Hand Function ◽  
User Acceptance ◽  
Chronic Stroke ◽  
Control Group ◽  
Home Based ◽  
Randomised Controlled ◽  
Clinical Changes ◽  
At Home

Objectives: To compare user acceptance and arm and hand function changes after technology-supported training at home with conventional exercises in chronic stroke. Secondly, to investigate the relation between training duration and clinical changes. Design: A randomised controlled trial. Setting: Training at home, evaluation at research institute. Subjects: Twenty chronic stroke patients with severely to mildly impaired arm and hand function. Interventions: Participants were randomly assigned to six weeks (30 minutes per day, six days a week) of self-administered home-based arm and hand training using either a passive dynamic wrist and hand orthosis combined with computerised gaming exercises (experimental group) or prescribed conventional exercises from an exercise book (control group). Main measures: Main outcome measures are the training duration for user acceptance and the Action Research Arm Test for arm and hand function. Secondary outcomes are the Intrinsic Motivation Inventory, Fugl-Meyer assessment, Motor Activity Log, Stroke Impact Scale and grip strength. Results: The control group reported a higher training duration (189 versus 118 minutes per week, P = 0.025). Perceived motivation was positive and equal between groups ( P = 0.935). No differences in clinical outcomes over training between groups were found (P ⩾ 0.165). Changes in Box and Block Test correlated positively with training duration ( P = 0.001). Conclusions: Both interventions were accepted. An additional benefit of technology-supported arm and hand training over conventional arm and hand exercises at home was not demonstrated. Training duration in itself is a major contributor to arm and hand function improvements.

scholarly journals Exergaming for Lower Limb Stroke Rehabilitation: A Game Controller for Lower Limb Stroke Rehabilitation

2021 ◽  
Author(s):  
◽  
RuiFeng Yeo
Keyword(s):  
Lower Limb ◽  
Stroke Rehabilitation ◽  
Weight Lifting ◽  
Ease Of Use ◽  
Neural Pathways ◽  
Game Controller ◽  
Research Findings ◽  
The Media ◽  
Task Training ◽  
At Home

<p><b>The success of stroke rehabilitation requires the patient engage in early, long-term high repetitions and intensive treatment. When comparing clinical and literature statistics, it is confirmed that clinical rehabilitation is not achieving required repetitions and intensity for effective rehabilitation of basic motor skills as prescribed in physiotherapy literature. It is then the patient’s responsibility to carry out the rehabilitation at home without supervision. These exercises can also be very mundane and repetitive, which reduces the patient’s motivation to exercise. Exergames have been found (Alankus et al., 2010, p. 21130, (King, Hijmans, Sampson, Satherley, & Hale, 2012 Deutsch et al., 2009), (Mortazavi et al., 2014), (Shirzad et al., 2015).to improve patients’ engagement with their therapies at home.</b></p> <p>Currently there are systems to facilitate lower limb stroke rehabilitation,but none includes Strength for Task Training (STT). STT is a novel physiotherapeutic method for lower limb rehabilitation and comprises of two main phases: first being the strength training (priming) and second being the task training. Priming is brief weight lifting to excite the neural pathways (neuroplasticity) in the affected region, which primes the brain for learning; this is then promptly followed by task training to maximise gains in the locomotor ability.</p> <p>This project builds up on the research and development of a game controller by Duncan (2016) for lower limb stroke rehabilitation to facilitate STT. This project is a collaboration with Regan Petrie who designed the media aspect of the exergame system.</p> <p>A game controller was developed and this was part of a complete exergaming system which was designed to specifically facilitate STT. This project compiles more research findings together with feedback from the user and the clinicians to help improve the system. This was to ensure that the design is aligned to the specific requirements of functional STT rehabilitation and contextual needs of the patient.</p> <p>The final output is a pair of prototype shoes which included a sensor to measure movement, a pair of weighted sleeve and a pair of balance sole. The weighted sleeve has removable weights and facilitates the strength part of the training. The shoes are the adaptors which allow the user to the balance soles which is used to constantly challenge the user’s balance. The sensors translate limb movement and are for the user to interact with the game. This system provides a simple and safe method to engage in unsupervised STT.</p> <p>Feedback from clinicians indicates that the shoes can facilitate the strength part of the exercise, the sensors the task part of the training, and the balance sole is useful for challenging and improving balance. User testing sessions offer information about: the usability of the system, including ease of use and intuitive design; the aesthetics of the physical objects and whether the system is engaging patients in their therapies.</p>

scholarly journals Reduced Worries of Hypoglycaemia, High Satisfaction, and Increased Perceived Ease of Use after Experiencing Four Nights of MD-Logic Artificial Pancreas at Home (DREAM4)

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Claudia Ziegler ◽  
Alon Liberman ◽  
Revital Nimri ◽  
Ido Muller ◽  
Simona Klemenčič ◽  
...  
Keyword(s):  
New Technology ◽  
Artificial Pancreas ◽  
Ease Of Use ◽  
Perceived Ease Of Use ◽  
Home Setting ◽  
Home Based ◽  
Level Of Satisfaction ◽  
High Level ◽  
The Impact ◽  
At Home

Aims.This study assesses the impact of using an AP-system at home on fear of hypoglycaemia. In addition, satisfaction and acceptance of the new technology are evaluated.Methods.In a multicentre, multinational study of 75 patients using the MD-Logic AP during four consecutive nights in home setting 59 of them (aged 10–54 years, 54% male, HbA1c 7.89 ± 0.69% [62.72 ± 7.51 mmol/mol], diabetes duration 11.6 ± 8.4 yrs) answered standardized questionnaires (HFS, adapted TAM, and AP satisfaction) before and after using the AP.Results.After experiencing the AP in home setting worries of hypoglycaemia were significantly reduced (before 1.04 ± 0.53 versus after 0.90 ± 0.63;P=0.017). Perceived ease of use as a measure of acceptance with the AP significantly increased after personal experience (before 4.64 ± 0.94 versus after 5.06 ± 1.09;P=0.002). The overall satisfaction mean score after using the AP was 3.02 ± 0.54 (range 0–4), demonstrating a high level of satisfaction with this technology.Conclusions.The four-night home-based experience of using MD Logic AP was associated with reduced worries of hypoglycaemia, high level of satisfaction, and increased perceived ease of use of the new technology in children, adolescents, and adults.

scholarly journals Dying at home of Covid-19: Meeting the need for home-based care

2020 ◽  
pp. 106409
Author(s):  
Cara Kiernan Fallon ◽  
Madison K. Kilbride
Keyword(s):  
Home Based ◽  
Dying At Home ◽  
Home Based Care ◽  
At Home

scholarly journals Initiation of therapy for obstructive sleep apnea syndrome: a randomized comparison of outcomes of telemetry-supported home-based vs. sleep lab-based therapy initiation

2021 ◽  
Author(s):  
Ingo Fietze ◽  
Sebastian Herberger ◽  
Gina Wewer ◽  
Holger Woehrle ◽  
Katharina Lederer ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Control Group ◽  
Sleep Laboratory ◽  
Home Therapy ◽  
Home Management ◽  
Therapy Initiation ◽  
Home Based ◽  
Obstructive Sleep ◽  
At Home

Abstract Purpose Diagnosis and treatment of obstructive sleep apnea are traditionally performed in sleep laboratories with polysomnography (PSG) and are associated with significant waiting times for patients and high cost. We investigated if initiation of auto-titrating CPAP (APAP) treatment at home in patients with obstructive sleep apnea (OSA) and subsequent telemonitoring by a homecare provider would be non-inferior to in-lab management with diagnostic PSG, subsequent in-lab APAP initiation, and standard follow-up regarding compliance and disease-specific quality of life. Methods This randomized, open-label, single-center study was conducted in Germany. Screening occurred between December 2013 and November 2015. Eligible patients with moderate-to-severe OSA documented by polygraphy (PG) were randomized to home management or standard care. All patients were managed by certified sleep physicians. The home management group received APAP therapy at home, followed by telemonitoring. The control group received a diagnostic PSG, followed by therapy initiation in the sleep laboratory. The primary endpoint was therapy compliance, measured as average APAP usage after 6 months. Results The intention-to-treat population (ITT) included 224 patients (110 home therapy, 114 controls); the per-protocol population (PP) included 182 patients with 6-month device usage data (89 home therapy, 93 controls). In the PP analysis, mean APAP usage at 6 months was not different in the home therapy and control groups (4.38 ± 2.04 vs. 4.32 ± 2.28, p = 0.845). The pre-specified non-inferiority margin (NIM) of 0.3 h/day was not achieved (p = 0.130); statistical significance was achieved in a post hoc analysis when NIM was set at 0.5 h/day (p < 0.05). Time to APAP initiation was significantly shorter in the home therapy group (7.6 ± 7.2 vs. 46.1 ± 23.8 days; p < 0.0001). Conclusion Use of a home-based telemonitoring strategy for initiation of APAP in selected patients with OSA managed by sleep physicians is feasible, appears to be non-inferior to standard sleep laboratory procedures, and facilitates faster access to therapy.

scholarly journals What does effective end-of-life care at home for children look like? A qualitative interview study exploring the perspectives of bereaved parents

2021 ◽  
pp. 026921632110233
Author(s):  
Cari Malcolm ◽  
Katherine Knighting
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Care Service ◽  
Life Care ◽  
Care Providers ◽  
Specialist Care ◽  
Bereaved Parents ◽  
Home Based ◽  
Qualitative Interview Study ◽  
At Home

Background: End-of-life care for children with life-shortening conditions is provided in a range of settings including hospital, hospice and home. What home-based, end-of-life care should entail or what best practice might look like is not widely reported, particularly from the perspective of parents who experienced the death of a child at home. Aim: To explore the value and assess the effectiveness of an innovative model of care providing home-based, end-of-life care as perceived by families who accessed the service. Design: A qualitative descriptive study design was employed with in-depth semi-structured interviews conducted with bereaved parents. Setting/participants: Thirteen bereaved parents of 10 children supported by the home-based end-of-life care service. Results: Parents reported effective aspects of end-of-life care provided at home to include: (1) ability to facilitate changes in preferred place of death; (2) trusted relationships with care providers who really know the child and family; (3) provision of child and family-centred care; (4) specialist care and support provided by the service as and when needed; and (5) quality and compassionate death and bereavement care. Parents proposed recommendations for future home-based end-of-life care including shared learning, improving access to home-based care for other families and dispelling hospice myths. Conclusion: Parents with experience of caring for a dying child at home offer valuable input to future the policy and practice surrounding effective home-based, end-of-life care for children. New models of care or service developments should consider the key components and attributes for effective home-based end-of-life identified by bereaved parents in this study.

scholarly journals Acceptability, Feasibility and Preliminary Evaluation of a Novel, Personalised, Home-Based Physical Activity Intervention for Chronic Heart Failure (Active-at-Home-HF): a Pilot Study

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Nduka C. Okwose ◽  
Leah Avery ◽  
Nicola O’Brien ◽  
Sophie Cassidy ◽  
Sarah J. Charman ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Heart Failure ◽  
Pilot Study ◽  
Chronic Heart Failure ◽  
Physical Activity Intervention ◽  
Step Count ◽  
Home Based ◽  
At Home

Abstract Purpose Less than 10% of heart failure patients in the UK participate in cardiac rehabilitation programmes. The present pilot study evaluated feasibility, acceptability and physiological effects of a novel, personalised, home-based physical activity intervention in chronic heart failure. Methods Twenty patients (68 ± 7 years old, 20% females) with stable chronic heart failure due to reduced left ventricular ejection fraction (31 ± 8 %) participated in a single-group, pilot study assessing the feasibility and acceptability of a 12-week personalised home-based physical activity intervention aiming to increase daily number of steps by 2000 from baseline (Active-at-Home-HF). Patients completed cardiopulmonary exercise testing with non-invasive gas exchange and haemodynamic measurements and quality of life questionnaire pre- and post-intervention. Patients were supported weekly via telephone and average weekly step count data collected using pedometers. Results Forty-three patients were screened and 20 recruited into the study. Seventeen patients (85%) completed the intervention, and 15 (75%) achieved the target step count. Average step count per day increased significantly from baseline to 3 weeks by 2546 (5108 ± 3064 to 7654 ± 3849, P = 0.03, n = 17) and was maintained until week 12 (9022 ± 3942). Following completion of the intervention, no adverse events were recorded and quality of life improved by 4 points (26 ± 18 vs. 22 ± 19). Peak exercise stroke volume increased by 19% (127 ± 34 vs. 151 ± 34 m/beat, P = 0.05), while cardiac index increased by 12% (6.8 ± 1.5 vs. 7.6 ± 2.0 L/min/m2, P = 0.19). Workload and oxygen consumption at anaerobic threshold also increased by 16% (49 ± 16 vs. 59 ± 14 watts, P = 0.01) and 10% (11.5 ± 2.9 vs. 12.8 ± 2.2 ml/kg/min, P = 0.39). Conclusion The Active-at-Home-HF intervention is feasible, acceptable and effective for increasing physical activity in CHF. It may lead to improvements in quality of life, exercise tolerance and haemodynamic function. Trial Registration www.clinicaltrials.gov NCT0367727. Retrospectively registered on 17 September 2018.

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