Smart rehabilitation for the 21st century: The Tampa Smart Home for veterans with traumatic brain injury

Abstract

INTRODUCTION In this editorial, we report on the development of a smart-home-based cognitive prosthetic that will deliver 24/7 rehabilitation at the James A. Haley Veterans' Hospital Polytrauma Transitional Rehabilitation Program (PTRP) facility in Tampa, Florida. The Tampa Smart Home was designed to address two weaknesses identified by PTRP clinicians in the rehabilitation process for patients with traumatic brain injury (TBI): (1) patient safety and (2) inadequate timing and repetition of prompts used to overcome TBI-related cognitive and memory deficits. Smart homes monitor residents' behaviors and provide assistance for various physical and neurological disabilities [1]. The Tampa Smart Home creates a pervasive supportive environment to assist cognitive rehabilitation in patients with TBI [2-3] by continuously identifying the movements and locations of all patient residents and clinical staff. The location information permits the intelligent software to deliver customized prompts and information to the patient via numerous interactive multimedia displays located on walls throughout the PTRP. The residential setting lends itself well to the enriched interactive rehabilitative environment, in which patients with TBI are immersed in their rehabilitation, and leverages the digital generation of veterans' active technology engagement to facilitate their own recovery [4]. A powerful feature of the Tampa Smart Home is the precision of the customized therapeutic information that can be provided to the recovering veteran. Individual-level data for every interaction with clinical and medical staff and with the interactive displays are recorded continuously and analyzed using state-of-the-art data mining, which, when fully implemented, will allow staff to visualize subtle but therapeutically significant behavioral changes to better inform treatment plans and potentially prevent untoward medication effects on veterans' memory, as well as gait and balance. This approach is expected to yield important insights into the cognitive recovery process by assisting therapists in targeting problem behaviors for remediation and then linking the behaviors to automata that ensure consistently provided therapy. Consistently delivered automated interventions will shorten recovery time while complementing or reducing therapist monitoring of patient locations and activities within the facility. BACKGROUND AND RELATED WORK Department of Veterans Affairs Polytrauma Centers The signature injuries of soldiers returning from Afghanistan and Iraq are polytrauma and TBI [5-6]. In the majority of Department of Veterans Affairs (VA) clinical cases, polytrauma and TBI are caused by blast injuries from improvised explosive devices, although TBI also results from noncombat events such as motor vehicle accidents. Polytrauma is defined as injuries to two or more body systems from one event. An extreme example would be injuries that simultaneously result in limb amputation, TBI, burns, deafness, and blindness, with long-term physical and cognitive impairments and functional disabilities. TBI, while part of the constellation of injuries encompassing polytrauma, is the most serious and common injury [5]. The variable emotional, cognitive, and behavioral consequences of TBI determine the specific course of rehabilitation [3]. Mild injuries, managed properly, have excellent recovery prospects; moderate to severe injuries require specialized care and intensive early rehabilitation and often require lifelong assistance to manage routine daily activities. The VA has four polytrauma centers that serve as regional centers for medical and rehabilitation care and hubs for research and education located in Minneapolis, Minnesota; Palo Alto, California; Richmond, Virginia; and Tampa, Florida. The comprehensive medical and rehabilitation services provided include acute medical care, outpatient programs, and PTRPs. …