Computer Assisted Rehabilitation Environment (C.A.R.E.) for Innovative

Telerehabilitation

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By Christopher Golby

Supervisors: Prof. Vinesh Raja

Prof. Gillian Hundt

Structure

• Stroke• Stroke Rehabilitation• Problems with Rehabilitation• Musculoskeletal Assessment• Telerehabilitation• System Design• System Testing

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Stroke

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Stroke

• “Strokes are caused by disruption of the blood supply to the brain.

• This may result from either blockage (ischemic stroke)

• or rupture of a blood vessel (hemorrhagic stroke).”[3]

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Stroke: The Symptoms

• Paralysis of One side of the body• Vision Problems• Speech Impairment• Hearing Difficulties• Impaired Neurological Activity• Swallowing Difficulties• Incontinence

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Musculoskeletal Rehabilitation

• Stroke results in a lesion

• Patients’ can lose the ability to move

• Neuroplasticity allows new neural pathways to form

• Patients can re-learn how to move

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Problems with RehabilitationTime Spent with Patients across 4 European Centers

Average Daily TherapyU.K. 1hrBelgium 2hrsGermany 2hrs 20minsSwitzerland 2hrs 46mins

Time Patient Spends Lying or SittingU.K. 5hrsBelgium 3.5hrsGermany <3hrsSwitzerland <3hrs

Time Spent in Direct TherapyU.K. Physiotherapy 45.9%U.K. Occupational Therapy 32.9%Germany Physiotherapy 66.1%Germany Occupational Therapy 63.3%

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Rehabilitation Costs

(£ billion)

Total Annual Direct Care Costs 2.80

Informal Care Costs 2.40

Total Annual Indirect Costs 1.80

Total Annual Cost 7.00

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Problems with Assessment

• National Clinical Guidelines for Stroke:

• “Many valid tools [outcome measures] exist, and although these guidelines do not specify which ones should be used, some suggestions are made in the appropriate parts of the document.”

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The Therapist’s View

• 2 West Midlands based stroke rehabilitation wards

• 10 Participants: –5 Occupational Therapists–5 Physiotherapists

• Strengths and Weaknesses of Rehabilitation in the UK

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Interviews: Results

• “I imagine Everywhere assesses slightly different”

• “We have outcome measures but all of them have got some kind of flaw.”

• “I think that the assessment needs to happen continuously. Whether the resources are there to support that is a completely and entirely different issue.”

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Interviews: Results

• “I think a lot of it does depend on the skills and the experience of the assessor.”

• “It can be again open to interpretation of whoever is scoring it”

• “Something that stops us using a lot of them is the time factor.”

• “We are not meeting the standards set out in the stroke strategy.”

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Problems with Assessment

• Subjectivity

• Standardisation

• Ad-Hoc Procedures

• Continuing Assessment

• Time

• Cost23/07/12 WMG 13

What Needs To Be Done

• Re-Engineer assessment for stroke rehabilitation

• Quantify outcome measures• Standardise the process• Provide continuing

assessment• Increase therapist efficiency• New tools must be low cost

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Tele-Rehabilitation

• “Conventional rehabilitation services at a distance, using telecommunication technology as the service delivery medium.”

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Hardware

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Two Stage System

• In-Hospital:–Sits in background during

rehabilitation.

• Post-Hospital:–Patient Carries on rehab at home–Adaptive system

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Inputs

• Inputs:

–ROM from:

• Elbow

• Shoulder

• Wrist

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Skeletal Tracking

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Outputs

• Outputs:–ADL tasks that the patient is capable

of performing

–Graphs detailing ROM during current session

–ROM over time can be used to predict recovery times.

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Range of Motion (R.O.M.) Graph

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TIME

R.O.M.

178°

37°

R.O.M. Over Time

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R.O.M.

Date

147°

37°

15°

Able-Bodied Testing

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• 30 Participants: –Snowball sampling starting with

university students and staff

• 3 Week Testing Period

Final System Testing

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• NHS Ethics Granted

• Up to 10 Stroke Patients

• Up to 15 Weeks of Testing

• 2 West Midlands based stroke rehabilitation wards

Conclusions and Contribution to Knowledge

• Identifies the need to re-engineer assessment for stroke patients, in a hospital setting and remotely

• Proposes a system, that if taken into the development stage, can provide the quantification of rehabilitation assessment data

• Provides a proof of concept in a healthcare setting

• Provides knowledge on how assessment for stroke patients can be improved through the use of low cost off-the-shelf hardware

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ANY QUESTIONS?

Thank you for listening.

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