Mobile Rehabilitation Research Articles

Continuous femoral nerve block is more effective than continuous adductor canal block for treating pain after total knee arthroplasty: A randomized, double-blind, controlled trial.

Previous studies comparing adductor canal block (ACB) with femoral nerve block (FNB) are inconclusive with regard to patient-controlled analgesia (PCA) induced by opioids. Moreover, some postoperative pain severity results differ between previous randomized controlled trials (RCTs). The primary aim of the current study was to compare total intravenous morphine consumption administered via PCA during the first postoperative day in continuous FNB and ACB groups after total knee arthroplasty (TKA). Secondary aims included evaluation of postoperative pain via a visual analog scale, degree of knee extension, quadriceps muscle strength, and ability to sit, stand upright, and walk. The study was a RCT. Inclusion criteria were presence of gonarthrosis, age >18 and <75 years, and scheduled for TKA under single-shot spinal anesthesia. A number of morphine uses was lower in the FNB group than in the ACB group (14, range 12-15 vs 20, range 18-22; P = .0001), and they perceived less severe pain at the 8th (P = .00003) and 24th hours. However, ACB was significantly superior with regard to most of the other parameters pertaining to mobility, including muscle strength at the 8th and 24th hours, degree of knee extension at the 8th hour, sitting at the 8th hour, standing upright at the 24th hour, and walking at the 24th and 48th hours. FNB was associated with the perception of less severe pain after TKAs. However, ACB was associated with earlier mobility rehabilitation.

Quantifying Functional Difference in Centre of Pressure Post Achilles Tendon Rupture using Sensor Insoles.

Significant advances are being made to instrument and more objectively quantify gait and mobility assessment, treatment and rehabilitation. Wearable, inertial, optical and location-based technologies are proposed as scalable soutions, suited to both clinic and home-based settings, that can provide clinically meaningful insights into gait and mobility. In this paper, sensorised insoles are shown to provide the means to measure where pressure is distributed through each foot for each step, while it is in contact with the ground. Through profiling the points through which pressure is applied over each step and comparing changes between the affected and healthy limbs, insights into biomechanical foot dysfunction are shown for a patient population which may inform assessment, treatment and rehabilitation. This paper proposes a series of sensor-agnostic metrics derived from sensorised insoles to quantify foot mobility over a series of steps in a patient population. Differences in these metrics are shown between the affected and unaffected foot in a cohort of patients 8 weeks post Achilles tendon rupture.

Evaluation of the Effectiveness of a Nursing/Physiotherapy Program in Chronic Patients.

This study aimed to evaluate the functional impact of a shared intervention model by the mobile physiotherapy and rehabilitation team (MPRT) and primary care case management nurses (PCCMNs) on chronic patients. This was a prospective, observational study involving 1086 patients (mean age, 80 years; 63.7% females) in the province of Almeria, which was conducted between 2004 and 2018. Most of the registered diseases included cerebrovascular and neurological diseases (56.7%), osteoarticular diseases (45.3%), diabetes mellitus (25.7%), cardiovascular diseases (25.5%), and chronic respiratory diseases. The study included a home care intervention by the MPRT and PCCMNs and included the following main outcome measures: age, sex, main caregiver, disabling process (ICD-9), type and number of inclusion categories for chronic disease, initial and final Barthel index (BI), treatment or intervention on the patient (techniques), objectives, and number of sessions. The main techniques used were kinesiotherapy (44.6%) and caregiver training (23%), along with technical aid. An equation predicting the patients’ final BI, according to the initial BI, was constructed using multiple linear regression modelling. A marked improvement in functional capacity was found after an average of 10 physiotherapy sessions. A lower patient age was correlated with a higher functional capacity, both initial and final BI, as well as a greater number of sessions.

Results of flexor tendon grafting with early active mobilization

Objective The aim was to evaluate the results of early active motion regimen after hand flexor tendon grafting. Background The application of proper postoperative rehabilitation program is an integral part to achieve good results after hand flexor tendon grafting. The aim of application of early, active mobilization rehabilitation program is to limit adhesion formation which limits active motion. Patients and methods Twenty-three fingers were managed by flexor tendon grafting and assessed from February 2015 till August 2016 at Menoufia University Hospital. In all, 17 fingers had two stages tendon grafting and six fingers had single-stage tendon grafting. Early active mobilization rehabilitation regimen was applied for all patients. Postoperative assessment was done by the American Society for Surgery of the Hand system, Strickland system, Buck-Gramcko method, and LaSalle formula. Results Final assessment was done at 6 months postoperatively and the results were as follows: good (52.17%), fair (39.13%), and poor (8.7%) according to the American Society for Surgery of the Hand system. According to the Strickland system, the results were excellent (13.04%), good (34.78%), fair (39.13%) and poor (13.04%). According to the Buck-Gramcko score, the results were excellent (21.7%), very good (17.4%), good (39.1%) good, fair (8.7%), and poor. (13.1%) According to LaSalle formula, the results were excellent (34.78%), good (52.17%), fair (8.7%), and poor (4.4%). Complications were adhesion formation (8.7%), infection (8.7%), flexor pulley rupture (4.3%), graft rupture (4.3%), and tourniquet palsy (4.3%). Conclusion The results were found to be affected by sex, dominance of affected hand, affected tendon(s), flexor pulley integrity, type of procedure, and by the type of tendon graft.

Three-Dimensional Augmented Reality System for Balance and Mobility Rehabilitation in the Elderly: A Randomized Controlled Trial.

We attempted to evaluate the clinical efficiency of a novel three-dimensional interactive augmented reality system (3D-ARS) for balance and mobility rehabilitation. This system enables participant training with a realistic 3D interactive balance exercise and assessing movement parameters and joint angles by using a kinetic sensor system. We performed a randomized controlled trial in a general hospital. Thirty-six participants (age, 56-76 years) who could independently walk and stand on one leg were recruited. The participants were randomly assigned to either group. The control group (n = 18) underwent a conventional physical fitness program such as lower-extremity strengthening and balance training thrice per week for 1 month. The experimental group (n = 18) experienced 3D-ARS training thrice per week (1 session = 30 minutes) for 4 weeks. Training comprised a balloon game for hip exercise, cave game for knee exercise, and rhythm game for one-leg balance exercise. Lower-extremity clinical scale scores, fall index, and automatic balance score were measured by using Tetrax® posturography before, during, and after training. Significant group (3D-ARS vs. control) × time (before and after exercise) interaction effect was observed for Berg balance scale (BBS) scores (p = 0.04) and timed-up-and-go (TUG; p < 0.001). Overall improvements occurred in stability index, weight distribution index, fall risk index, and Fourier transformations index of posturography for both groups. However, score changes were significantly greater in the 3D-ARS group. Significant group × time interaction effect was observed for the fall risk index. This demonstrates that the 3D-ARS system can improve balance in the elderly more effectively.

Bodily Felt Freedom: an Ethical Perspective on Positive Aspects of Deep Brain Stimulation

The critical aspects of deep brain stimulation (DBS) are usually the focus of the ethical debate about the implantation of electrodes into the brain of patients with Parkinson’s disease (PD). Above all, potential postoperative side effects on personality caused by DBS mark the debate. However, rehabilitation of agility and mobility by DBS can be posited against critical aspects. Therefore, the purpose of this article is to emphasize the hitherto neglected positive aspects of that technology. A detailed study of the rehabilitation of controlled movements will thus be the object of this article. The possibility to move again in a controlled way will be discussed as freedom of movement. The concept freedom of movement is being linked to the observation of feelings of euphoria and joy that can occur after surgery for patients with PD stimulated in the subthalamic nucleus (STN). This is done based on phenomenological analysis and qualitative interviews, in which the relation between freedom of movement and feelings of joy becomes clear. The aim here is to show that these feelings of exaltation express an essential feeling of freedom – a bodily felt freedom – which is grounded in movement and can be regained by STN-DBS.

EEG-Based BCI Control Schemes for Lower-Limb Assistive-Robots.

Over recent years, brain-computer interface (BCI) has emerged as an alternative communication system between the human brain and an output device. Deciphered intents, after detecting electrical signals from the human scalp, are translated into control commands used to operate external devices, computer displays and virtual objects in the real-time. BCI provides an augmentative communication by creating a muscle-free channel between the brain and the output devices, primarily for subjects having neuromotor disorders, or trauma to nervous system, notably spinal cord injuries (SCI), and subjects with unaffected sensorimotor functions but disarticulated or amputated residual limbs. This review identifies the potentials of electroencephalography (EEG) based BCI applications for locomotion and mobility rehabilitation. Patients could benefit from its advancements such as wearable lower-limb (LL) exoskeletons, orthosis, prosthesis, wheelchairs, and assistive-robot devices. The EEG communication signals employed by the aforementioned applications that also provide feasibility for future development in the field are sensorimotor rhythms (SMR), event-related potentials (ERP) and visual evoked potentials (VEP). The review is an effort to progress the development of user's mental task related to LL for BCI reliability and confidence measures. As a novel contribution, the reviewed BCI control paradigms for wearable LL and assistive-robots are presented by a general control framework fitting in hierarchical layers. It reflects informatic interactions, between the user, the BCI operator, the shared controller, the robotic device and the environment. Each sub layer of the BCI operator is discussed in detail, highlighting the feature extraction, classification and execution methods employed by the various systems. All applications' key features and their interaction with the environment are reviewed for the EEG-based activity mode recognition, and presented in form of a table. It is suggested to structure EEG-BCI controlled LL assistive devices within the presented framework, for future generation of intent-based multifunctional controllers. Despite the development of controllers, for BCI-based wearable or assistive devices that can seamlessly integrate user intent, practical challenges associated with such systems exist and have been discerned, which can be constructive for future developments in the field.

Associations between post-operative rehabilitation of hip fracture and outcomes: national database analysis

BackgroundRehabilitation programmes are used to improve hip fracture outcomes. There is little published trial clinical trial or population-based data on the effects of the type or provider of rehabilitation treatments on hip fracture outcomes. We evaluated the associations of rehabilitation interventions with post-operative hip fracture outcomes.MethodsCross-sectional (2013–2015) analysis of data from the English National Hip Fracture Database (NHFD) from all 191 English hospitals treating hip fractures. Of 62,844 NHFD patients, we included 17,708 patients with rehabilitation treatment and 30-day mobility data, and 34,142 patients with rehabilitation treatment and discharge destination data. The intervention was early mobilisation rehabilitation treatments delivered by a physiotherapist (PT, physical therapist in North America) or other clinical staff as identifiable in NHFD. We used ordinal logistic and propensity scoring regression models to adjust for confounding variables including age, sex, pre-fracture mobility, operative delay, and cognitive function and peri-operative risk scores.ResultsIn both the adjusted multivariate and propensity-weighted analyses, mobilisation on the day or the day following surgery is associated with better mobility function 30 days after discharge. However patients mobilised by a PT did not have better mobility compared to mobilisation by other professionals. Patients who received a PT assessment were not protected from poorer mobility 30 days after discharge, compared with those who did not receive an assessment. The discharge destination outcome is also better in mobilised than unmobilised patients, whether done by a PT or another health professional, and the difference persists, slightly attenuated, after propensity weighting.ConclusionsIn addition to the type of health professional initiating mobilisation, data on rehabilitation treatment activity and post-operative gait speed is needed to determine optimum rehabilitation dosage and functional outcome. After adjustment patients mobilised by non-PTs did as well as patients mobilised by PTs, suggesting that PTs’ current roles in very early rehabilitation should be reconsidered, with a view to redeploying them to more specialised later rehabilitation activity.

Home rehabilitation in France. The model of stroke

Ambulatory care is the most frequent type of rehabilitation for chronic diseases. French guidelines recommend after a stroke assessment and rehabilitation by a multidisciplinary team for all the patients with a persistent deficiency. According to the needs of each patient, different ways to provide home rehabilitation can be used in France. For simple needs targeting specific deficiency, rehabilitation can be provided by a professional alone in ambulatory care. Only Physiotherapy (PT) and speech therapy (ST) are refunded by the national health insurance. For complex needs a PRM multidisciplinary team, can be ordered either in day hospital (the patient living home and receiving rehabilitation during repeated stays) which is the main organization, or mobile rehabilitation team, the team coming each day at home like an early supported discharge team (not very developed in France). We report here the global activity base on the analysis of the national registry on the 80,000 annual new strokes (excluding transient attacks and deceased) After the acute care, 37% of stroke patients received a multidisciplinary rehabilitation during a mean of 3 months (33% in an inpatient center and 4% in an outpatient center). For the patient discharge at home 30% (directly discharge from an acute center) to 50% (discharge from a rehabilitation center) receive PT and 9 to 15% ST. At the chronic phase 35% of the patients receive PT at home. Ambulatory occupational therapy and ST are less developed and less available. Effort is needed to improve multidisciplinary rehabilitation at home in France. Home hospital could be interesting to develop for dependent and fragile patients, mobile rehabilitation team for the rehabilitation of the instrumental activities of daily livings, and day hospital for rehabilitation requiring technical platform of a rehabilitation center.

Radial Distraction to Stabilize Distal Radioulnar Joint in Distal Radius Fixation.

Persistent distal radioulnar joint (DRUJ) instability after internal fixation of distal radius fractures can be managed with soft tissue or bony stabilization and prolonged immobilization. However, these strategies limit postoperative motion. To address this limitation, we report our technique of indirect ulna shortening by radial distraction followed by early mobilization and provide a case example. We use this technique in cases of persistent DRUJ instability during standard volar plating of distal radius fractures. Radial lengthening is achieved by distraction through the fracture site using the oblong hole of the plate until DRUJ stability is obtained. No immobilization of forearm rotation and a standard, early mobilization rehabilitation program are used. Indirect ulnar shortening by distraction through the distal radius fracture site providesa simple and novel strategy for the management of persistent DRUJ instability during volar plating, obviating the need for prolonged immobilization or to alter standard postoperative protocols.

Surgery and Rehabilitation Following Flexor Tendon Zone II Injury Of The Hand: A Literature Review

Background : Flexor tendon injury of the hand is common and it used to end up with poor outcomes. It gives negative effects to patient’s daily life. Successful treatment for these cases is a challenge for surgeons. Before 1967, Injury in Zone II was called as “No Man’s Land”. Flexor tendon repair and rehabilitation have been substantially improved through advances in repair and rehabilitation. Method : We reviewed literatures from PubMed, MEDLINE, Cochrane and Google Scholar. It was researched using the terms flexor tendon zone II injury, flexor tendon zone II repair and flexor tendon zone II rehabilitation. Topics covered included anatomy, suture repair and material, and rehabilitation. Result : There is no significant difference of rupture rates and functional outcomes in the number of core suture. Braided polyester suture is the choice for core suture and monofilament for peripheral suture. There is no significant difference in rehabilitation using early passive motion or early active motion. The preference for post operative treatment is by using short splint without immobilization of the wrist. Discussion : Repair sutures techniques and suture materials have been improved as well as active mobilization rehabilitation protocols including a change of wrist position by modification of splints. Improvement in putting splint from a traditional dorsal blocking splint into splint that not immobilize the wrist. Despite all of these modifications, tendon ruptures have not been eliminated. The definitive answer remains elusive.

THE THREE-DIMENSIONAL MOVEMENT CORRELATIONS BETWEEN ELBOW AND WRIST JOINT AND ANTHROPOMETRIC DETERMINANTS

This study aimed to investigate three-dimensional (3D) kinematic characteristics of elbow and wrist motions, the relationship between them, and the anthropometric factors affecting them. Using motion capture system, this study measured and calculated the 3D angles of elbow flexion/extension, elbow pronation/supination, wrist flexion/extension, and wrist adduction/abduction of 40 healthy young adults. The study measured nine anthropometric variables and used unpaired [Formula: see text]-tests to assess gender difference. Also, bivariate correlation tests and step-wise multiple regression analyses were performed between joint ranges and anthropometric variables, as well as different joint motions. Results showed two opposite patterns occurred during elbow flexion/extension. The study found a correlation between the range of elbow flexion/extension and the range of elbow pronation/supination that occurred during elbow flexion/extension. Additionally, the study tested joint correlations between the four joint motions. Finally, the study established bivariate and multiple regression relationships between range of elbow motions and anthropometric factors. This research presented an unrecognized pattern of 3D elbow flexion/extension, and associations between various anthropometric factors and different joint motions. These findings can contribute to the design of orthosis of upper extremities and the rehabilitation of joint mobility.

Intensive multidisciplinary home rehabilitation for older people with severe conditions

Introduction : Older people often demonstrate multiple physical and functional problems simultaneously. For this reason, geriatric rehabilitation (GR) is often organized as integrated care with a multidisciplinary team providing a structured care plan to alleviate or reduce the consequences of the patients’ conditions. However, some of those in need of GR have difficulties to adapt to the hospital settings and therefore do not profit from the intense multidisciplinary care provision in such a setting as would be desirable. These patients are often finishing their rehabilitation without being able to walk independently, or manage their daily life. Practice change implemented : Since 2007, the German health care system offers a home-based GR for geriatric patients, called Mobile Rehabilitation (MR), within the same framework as the standard GR in a hospital setting, providing an intensive and multidisciplinary rehabilitation program over 6 to 8 weeks. Aim and theory : There is good evidence on the effectiveness of rehabilitation and home care concepts in general. However, several risk factors such as the presence of cognitive or psychological disorders, or seeing and hearing impairments, among others, lead to unsatisfactory result of a rehabilitation program. that can be attributed to problems of a geriatric patient to adapt to the requirements of a rehabilitation program. Possible reasons are the presence of cognitive or psychological disorders, or seeing and hearing impairments, among others. Such patients can, in theory, largely profit from MR in their accustomed environment. Intervention program and timeline : The MR program consists of, on average, 40 sessions of physiotherapy, occupational therapy, speech therapy or nursing care with 6 sessions each week. Regular multidisciplinary team meetings are under the leadership of a geriatrician. Highlights : First publications on this program demonstrate its general effectiveness. Additionally, results from the project MORECARE, a German-based, national research project aiming at identifying and overcoming organizational and managerial barriers in providing home-based GR in Germany will be presented. Comments on sustainability and transferability : In 2016, the concept of MR has been broadened and includes now several additional conditions associated with a decreased adaptability to conventional rehabilitation settings. This decision was based on the first evidence on it’s effectiveness. This presentation will enable stakeholders who provide integrated care for older people to reflect on the additional value of MR as an alternative to conventional GR as well as managerial prerequisites in implementing such concepts in their respective health care system. Conclusions : The MR program presented here is able to improve outcomes in a subgroup of geriatric patients who do not profit from conventional rehabilitation programs. Discussions : While the current literature demonstrates the potential benefits of MR, the evidence is still limited. Additionally, the implementation of such a program lead to some organizational problems, which have to be discussed. Lessons learned : The audience of this presentation will learn on the potential of the MR program as an alternative to conventional rehabilitation, its multidisciplinary building blocks and the identified barriers and problems in implementing and continuing this program.

Mobile Rehabilitation System Induce the Active Engagement on FES Training in Patients with Stroke

Mobile Rehabilitation System Induce the Active Engagement on FES Training in Patients with Stroke

Originality and interests of the mobile rehabilitation and reintegration Team (EM3R) for patient with brain disease at the university hospital of Strasbourg

Established in 2014, the EM3R of the University Institute of Rehabilitation Clemenceau (IURC) of Strasbourg is a team of support and coordination for the patients with cerebral disease. It differs from a mobile 2R team (rehabilitation, readaptation) by its precocity of action and from a traditional 3R mobile team because it does not realize direct rehabilitation care. Its activity is realized with one physician doctor, one occupational therapist and one medical secretary of the IURC. Our activity will be summarized as follow: Specificity: out of a thousand annual evaluations, 95% concern patient with brain lesions, 5% other diseases. Reactivity: 70% of evaluations are realized within 72 hours post-report. Precocity: 30% of evaluations are performed within 72 hours following the advent of the disease. This low figure is due to the fact that the units are slow to call the EM3R. Coordination: If it is necessary to start quickly the treatments combining physiotherapy, occupational therapy and language therapy, they will only be fully effective if they are coordinated. The specialist EM3R physician has the capacities of this coordination and helps to set up a specific rehabilitation project, project discussed weekly with the rehabilitation team of the Stroke Unit, of the intensive care unit and neurosurgery. The EM3R through its knowledge of the rehabilitation and of the social care units, propose in conjunction with these short-stay teams, the most appropriate care pathway: “The right patient at the right place”. The EM3R try to Improve the care by professional training (caregivers, paramedical and medical teams) and by carrying out specific technical acts usually realized later in rehabilitation centers (thermoplastic splints, botulin toxin). Our Strasbourg EM3R does not provide home care and direct rehabilitation care, which distinguishes it from conventional EM2R and EM3R. Nevertheless, our team is an indispensable actor in the quality and the effectiveness of the medical care by dint of the precocity of evaluation, the knowledge of the management of patients with cerebral disease, the coordination of physiotherapy cares, the realization of specific treatment and the knowledge of rehabilitation and social structures.

Building Research Capacity in a Mobile Psychiatric Rehabilitation Program: Service Learning in a University-Agency Collaboration

Social service agencies face increasing demands for accountability, emphasizing the necessity of preparing professionals to effectively evaluate practice. University-agency collaborations incorporating service learning can build community research capacity while providing opportunities for application of student research skills. We describe a partnership model between a Master of Social Work program evaluation course and a mobile psychiatric rehabilitation program to design a formative evaluation. Course structure and tasks central to the management of the partnership are described. Agency staff benefited from access to peer-reviewed literature, introduction to standardized assessment instruments, and stimulation of staff discussion and critical thinking around service provision. Students valued the applied research experience including exposure to the agency context and a real-world impact of their work. Lessons learned and implications for university-agency collaborations are discussed.

A novel smartphone camera-LED Communication for clinical signal transmission in mHealth-rehabilitation system.

In this paper, an implementation of mobile-Visible Light Communication (mVLC) technology for clinical data transmission in home-based mobile-health (mHealth) rehabilitation system is introduced. Mobile remote rehabilitation program is the solutions for improving the quality of care of the clinicians to the patients with chronic condition and disabilities. Typically, the program inquires routine exercise which obligate patients to wear wearable electronic sensors for hours in a specific range of time. Thus it motivate us to develop a novel harmless biomedical communicating system since most of the device's protocol was based on RF communication technology which risky for a human body in term of long term usage due to RF exposure and electromagnetic interference (EMI). The proposed system are designed to utilize a visible light as a medium for hazardless-communication between wearable sensors and a mobile interface device (smartphone). Multiple clinical data such as photoplethysmogram (PPG), electrocardiogram (ECG), and respiration signal are transmitted through LED and received by a smartphone camera. Furthermore, a smartphone also used for local interface and data analyzer henceforth sent the data to the cloud for further clinician's supervision.

The Effectiveness of Early Active Mobilization in Zone II Flexor Tendon Repair Rehabilitation: A Systematic Review

Abstract Date Presented 3/31/2017 This systematic review identified that early active mobilization rehabilitation protocols, when used in the clinic and as home exercise, result in overall good to excellent return of function in upper extremities that sustained Zone II flexor tendon repairs. Primary Author and Speaker: Amy Beribak Additional Authors and Speakers: Vanessa Jewell Contributing Authors: Frankey Ukey

Technical Developments for Rehabilitation of Mobility

AbstractTechnically assisted rehabilitation of mobility after stroke has been well established for several years. There is good evidence for the use of end-effector devices, exoskeletons and treadmill training with and without body weight support. New developments provide the possibility for functional training during mobilization, even in intensive care units. Mobile exoskeleton devices have been developed, but their clinical effects need still to be evaluated. All devices should not only focus on increasing the number of repetitions, but also include motivational aspects such as virtual reality environments. Hygienic aspects impose a special challenge. All devices should be integrated into a rational and clearly-defined therapy concept.

Mobile Tablet-Based Stroke Rehabilitation: Using mHealth Technology to Improve Access to Early Stroke Rehabilitation

&lt;p class="Abstract"&gt;Mobile health (mHealth) technology represents a means through which more stroke survivors could access early stroke rehabilitation. Although rehabilitation is most effective when begun early post-stroke, limited resources (facilities, therapists) prevent survivors from initiating therapy. Furthermore, the coupling of an aging population with advances in acute therapy has led to an increase in the absolute number of individuals suffering from and surviving strokes which in turn has put further strain on already scarce rehabilitation resources. There is an urgency to conduct high-quality research exploring cost-effective and creative mHealth devices for early rehabilitation in the acute setting. Mobile technology allows therapists to prescribe apps based on standard cognitive/physical assessments in the acute setting, remotely monitor patient progress across individual carepaths, and update prescribed therapies based on patient feedback and recovery. Recognition of the growing problem of accessing early stroke rehabilitation, and the possibilities offered by mHealth technology led to the development of the RecoverNow platform for stroke rehabilitation in the acute setting. RecoverNow is a custom built, tablet-based stroke rehabilitation platform that houses a variety of previously existing apps with activities analogous or identical to exercises in speech language and/or occupational therapy. While RecoverNow represents how mobile technology can be utilized to address a growing public health issue, the feasibility, acceptability and efficacy of tablet-based stroke rehabilitation are unknown. Studies with the goal of establishing feasibility of early tablet-based stroke rehabilitation are needed and, if appropriate, a randomized controlled trial to establish efficacy.&lt;/p&gt;