Remote Therapist Research Articles

EMG model calibration and trajectory tracking of rehabilitation exoskeleton by asynchronous tele-training

ABSTRACT This study presents a novel kinematic tracking model, designed for a networked exoskeleton system that is asynchronously taught by a remote therapist. The therapist’s rehabilitation exercises are quantitatively assessed using a monocular vision system. The resultant metrics are then transmitted asynchronously over the network to patients equipped with exoskeletons. The exoskeleton utilises these metrics as reference paths for exercises, complemented by electromyography (EMG) feedback. This work introduces a calibration approach aimed at estimating angular positions by utilising EMG observations. The calibration model establishes real-time correlations between polynomial reference positions. We further explore redundant kinematics, incorporating an EMG observer for linear, time-variant rehabilitation tracking control. Our methodology is validated using vision-based metric data and experimental EMG measurements including shoulder flexion, elbow flexion, and rowing-like movements. Computer simulations demonstrate the system’s ability to reliably, robustly, and effectively follow desired trajectories. This research offers a promising approach for remote personalized rehabilitation.

Virtual Hybrid Versus In-Person Administration of Transcending Self Therapy for Veterans with Substance Use Disorders.

Veterans with substance use disorder (SUD) can show high severity and are at high risk of relapse due to trauma histories and other comorbid conditions. However, evidence-based SUD therapies may not be available to many veterans due to geographic or transportation constraints. Telehealth approaches have shown promise to improve access to different SUD therapy formats but have not been well-studied in open (rolling-admission) group therapy of in-person patients as administered by a single on-screen therapist. Social distancing required by the COVID-19 pandemic forced the transition of delivery of Transcending Self Therapy (TST) from an in-person therapist to a single remote (on-screen) therapist. In this virtual model, veterans continued to receive TST but the therapist was off site and provided therapy to veterans who were together in the same room during a 28 day residential Veterans Affairs treatment program. In a program evaluation, we compared their changes in quality of life (QoL), treatment satisfaction ratings and group therapy treatment outcomes with those of Veterans who received TST from an in-person therapist. In both groups, there was a significant increase in QoL Inventory scores from baseline to post-treatment, with no difference in improvement between treatment modalities (i.e., in-person group vs telehealth-delivered group). Veterans professed knowledge of therapy-driven skills at the end of treatment in both groups and overwhelmingly rated TST as helpful and understandable. These data extend previous findings of patient acceptability of remotely-delivered SUD treatment, here with a remote therapist administering open group therapy, as evidenced by improvement in QoL and positive patient feedback about the remote intervention.

More than doubling the clinical benefit of each hour of therapist time: a randomised controlled trial of internet cognitive therapy for social anxiety disorder.

Cognitive therapy for social anxiety disorder (CT-SAD) is recommended by NICE (2013) as a first-line intervention. Take up in routine services is limited by the need for up to 14 ninety-min face-to-face sessions, some of which are out of the office. An internet-based version of the treatment (iCT-SAD) with remote therapist support may achieve similar outcomes with less therapist time. 102 patients with social anxiety disorder were randomised to iCT-SAD, CT-SAD, or waitlist (WAIT) control, each for 14 weeks. WAIT patients were randomised to the treatments after wait. Assessments were at pre-treatment/wait, midtreatment/wait, posttreatment/wait, and follow-ups 3 & 12 months after treatment. The pre-registered (ISRCTN 95 458 747) primary outcome was the social anxiety disorder composite, which combines 6 independent assessor and patient self-report scales of social anxiety. Secondary outcomes included disability, general anxiety, depression and a behaviour test. CT-SAD and iCT-SAD were both superior to WAIT on all measures. iCT-SAD did not differ from CT-SAD on the primary outcome at post-treatment or follow-up. Total therapist time in iCT-SAD was 6.45 h. CT-SAD required 15.8 h for the same reduction in social anxiety. Mediation analysis indicated that change in process variables specified in cognitive models accounted for 60% of the improvements associated with either treatment. Unlike the primary outcome, there was a significant but small difference in favour of CT-SAD on the behaviour test. When compared to conventional face-to-face therapy, iCT-SAD can more than double the amount of symptom change associated with each therapist hour.

The effects of concurrent cognitive and meta‐cognitive training on neuropsychiatric symptoms of people living with younger onset dementia: Protocol for a pilot trial

AbstractBackgroundNeuropsychiatric symptoms (NPS) are behavioural and psychological disturbances frequent in people with dementia that have been linked with lower quality of life, lower cognitive functioning and greater caregiver distress, especially for caregivers of people with younger‐onset dementia (YOD) (1).Several drug and non‐drug treatments targeting NPS have been investigated in recent years. However, to the best of our knowledge, no treatment has been developed that concurrently targets and trains cognitive and meta‐cognitive processes which are implicated in the expression of NPS. The aim of this pilot trial is to investigate the effects on NPS of a mobile application‐based intervention simultaneously training both processes by incorporating elements of cognitive training and cognitive‐behavioural therapy.MethodTwenty participants with YOD will be randomised to the training group or to a control group. Participants in the experimental condition will train at home three times a week for four weeks with remote therapist support. NPS, cognitive, psychological and caregiver outcomes will be assessed before and immediately after the intervention.ResultThe mobile application is in the design stage and further studies are underway to incorporate the views of people with YOD and their care‐partners, as well as clinicians, to the design. Recruitment of participants is expected in the second half of 2021.ConclusionFindings from this trial will further our understanding of the utility of concurrently targeting cognitive and meta‐cognitive processes in people with YOD when treating NPS and will inform a revision of the application. We believe that results from this study will have important implications for the management and treatment of NPS in the ever‐growing field of interventions utilising technology. 1 Baillon, S., Gasper, A., Wilson‐Morkeh, F., Pritchard, M., Jesu, A. and Velayudhan, L., 2019. Prevalence and Severity of Neuropsychiatric Symptoms in Early‐ Versus Late‐Onset Alzheimer’s Disease. American Journal of Alzheimer's Disease & Other Dementias®, 34(7‐8), pp.433‐438.

Tele-Rehabilitation Versus Local Rehabilitation Therapies Assisted by Robotic Devices: A Pilot Study with Patients

The present study aims to evaluate the advantages of a master-slave robotic rehabilitation therapy in which the patient is assisted in real-time by a therapist. We have also explored if this type of strategy is applicable in a tele-rehabilitation environment. A pilot study has been carried out involving 10 patients who have performed a point-to-point rehabilitation exercise supported by three assistance modalities: fixed assistance (without therapist interaction), local therapist assistance, and remote therapist assistance in a simulated tele-rehabiliation scenario. The rehabilitation exercise will be performed using an upper-limb rehabilitation robotic device that assists the patients through force fields. The results suggest that the assistance provided by the therapist is better adapted to patient needs than fixed assistance mode. Therefore, it maximizes the patient’s level of effort, which is an important aspect to improve the rehabilitation outcomes. We have also seen that in a tele-rehabilitation environment it is more difficult to assess when to assist the patient than locally. However, the assistance suits patients better than the fixed assistance mode.

The association between therapeutic alliance and outcome in internet-based psychological interventions: A meta-analysis

BackgroundInternet-based psychological interventions have proven effective and yield advantages that make them a viable alternative to face-to-face therapy in many fields. Yet, the role of therapeutic alliance in technologically mediated interventions has been discussed critically. The aim of this meta-analysis is to summarize the association between therapeutic alliance and outcome in therapist-assisted online interventions. MethodsA systematic search of the databases PubMed, Web of Science, PsycINFO and PubPsych was conducted for articles published before February 2020 that assess the association between therapeutic alliance and outcome in internet-based interventions involving remote therapist contact. Results were systematically screened and information on the alliance-outcome-association was extracted. A multilevel meta-analysis was conducted. ResultsOverall, 51 effect sizes were extracted from 20 included studies. The average weighted effect size is r = 0.203 (p < .0001). The correlation was larger when alliance was measured near the end of an intervention. There was no impact of therapist contact frequency or mode and availability of self-help content on the effect size. ConclusionsTherapeutic alliance and outcome are significantly correlated in internet-based therapy. This points to the relevance of a stable alliance in internet-based interventions and suggests that fostering alliance might be beneficial to treatment success.

Zorabots: A suitable robot-mediated telerehabilitation interface

Research on NAO robot-mediated Autism Spectrum Disorder (ASD) therapy intervention via telerehabilitation network has been gaining popularity in recent years. It eliminates the distance barrier between a therapist and a child with autism by allowing remote physical interactions between them thus enabling the therapy to be conducted even in a long-distance. In general, the system requires a robot, a child with autism, and a helper which normally is a close kin to be present at one place and a specialized therapist at another. Connected via remote communication technology such as the Internet of Robotics Things (IoRT), a remote therapist is able to monitor the therapy session through robot vision or its sensors and if necessary, provide physical feedbacks through robotic features such as voice or body movements. One of the system’s important aspects is the therapist’s interface controlling the robot. The interface must be user-friendly to non-programmer user yet having enough technical features to control a sophisticated NAO robot. Choregraphe, an official NAO robot platform and interface to program and control the NAO robot, has many advanced programming functions. Thus, it is considered quite intimidating to the non-programmer user, in this case, a specialized therapist. As an alternative to this interface, this paper reviews the suitability of commercially available software, Zorabots, as the therapist’s interface to monitor and control NAO Robot in telerehabilitation environments.

Technology Matters: The human touch in a digital age - a blended approach in mental healthcare delivery with children and young people.

Online psychological interventions have the potential to address many current issues facing service provision in child and adolescent mental health, not least improving access to evidence-based therapies and providing greater patient choice. Recognising this, the National Institute for Health and Care Excellence (NICE) now recommend digitally delivered therapy in the treatment of depression in children and young people (CYP). However, despite the virtual ubiquity of technology in young people's lives, and good evidence that online treatments can be effective, there remain barriers to real-world implementation. We argue that remote therapist support and blended approaches to therapy will be important models in harnessing the potential of digital technology in CYP mental health.

Current Telerehabilitation Research With Older Adults at Home: An Integrative Review.

Increased demand for in-home rehabilitation services for older adults may be met through telerehabilitation information and communication technologies. The current article reports the results of an integrative literature review summarizing current in-home telerehabilitation research with older adults. Nine studies from 2006-2015 are included. Six studies employed a remote therapist using real-time video. Three studies used text- or web-based messaging and electronic surveys. Six studies relied on dial-up Internet service and the remaining three studies used broad-band Internet connections. Future research should address (a) in-home and wearable sensing technologies to monitor health and (b) mobile devices, such as tablet computers, to collect patient self-reports. Interoperable platforms are needed to integrate disparate devices and support continuity of care across post-acute care settings. [Journal of Gerontological Nursing, 42(10), 15-20.].

A Fully Automated, Quantitative Test of Upper Limb Function

ABSTRACT. The Rehabilitation Joystick for Computerized Exercise (ReJoyce, Rehabtronics Inc., Edmonton, Alberta, Canada), is a workstation on which participants exercise dexterous movement tasks in the guise of computer games. The system incorporates the ReJoyce Arm and Hand Function Test (RAHFT). Here the authors evaluate the RAHFT against the Action Research Arm Test (ARAT) and the Fugl-Meyer Assessment (FMA). All 3 tests were performed in 36 separate sessions in 13 tetraplegic individuals. Concurrent and criterion validities of the RAHFT were supported by a high level of correlation with the ARAT (r2 = .88). Regarding responsiveness, the effect size of the RAHFT at week 6 of 1 hr/day exercise training was 1.8. Regarding reliability, the mean test–retest difference in RAHFT baseline scores was 0.67% ± 3.6%, which was not statistically significant. The RAHFT showed less ceiling effect than either ARAT or FMA. These data help validate the RAHFT as a quantitative, automated alternative to the ARAT and FMA. The RAHFT is the first comprehensive test of arm and dexterous hand function that does not depend on human judgment. It offers a standardized, quantitative outcome evaluation, which can be performed not only in the clinic, but also in the participant's home, administered by a remote therapist over the Internet.

World Federation of occupational therapists' position statement on telehealth.

The purpose of this document is to state the World Federation of Occupational Therapists’ (WFOT) position on the use of telehealth for the delivery of occupational therapy services. Telehealth is the use of information and communication technologies (ICT) to deliver health-related services when the provider and client are in different physical locations. Additional terms used to describe this service delivery model include: tele-occupational therapy, telerehabilitation, teletherapy, telecare, telemedicine, and telepractice, among other terms. Telehealth may be used by occupational therapy practitioners for evaluation, intervention, monitoring, supervision, and consultation (between remote therapist, client, and/or local health-care provider) as permitted by jurisdictional, institutional, and professional regulations and policies governing the practice of occupational therapy. Occupational therapy services via telehealth should be appropriate to the individuals, groups and cultures served, and contextualized to the occupations and interests of clients. Important considerations related to licensure/registration, collaboration with local occupational therapists, client selection, consent to treat, professional liability insurance, confidentiality, personal and cultural attributes, provider competence/standards of care, reimbursement/payer guidelines, and authentic occupational therapy practice are discussed.

G130 E-therapies for mental health problems in children and young people: A systematic review and focus group investigation

AimsTo review the effectiveness of e-mediated therapies and computer applications for children and young people (CYP) with mental health (MH) problems.To conduct focus groups eliciting service users views on computer-based...

Remote treatment of obsessive-compulsive disorder: A randomized controlled trial

Obsessive-compulsive disorder (OCD) is a common anxiety disorder. Although effective treatments exist many patients experience difficulties accessing treatment. Treatments that are delivered remotely, such as bibliotherapy-administered CBT (bCBT) and internet-administered CBT (iCBT) have the potential to improve access to treatment. This study was a three group randomized controlled trial that aimed to examine the benefits and acceptability of these two remote treatment options in the treatment of OCD, compared to a waitlist control group. Participants in the bCBT and iCBT groups read five lessons and received twice-weekly contact from a remote therapist. The control group did not receive any clinical contact during this time. The results indicated that participants in both remote treatment conditions (bCBT and iCBT) improved from pre-treatment to post-treatment and pre-treatment to 3-month follow-up on the Yale-Brown Obsessive Compulsive Scale. Once the bCBT and iCBT groups completed treatment, the control group was provided the iCBT protocol but with clinician contact only once per week. Results from the control group, after receiving iCBT treatment, indicated that large effect sizes can be obtained with weekly contact. These results provide preliminary support for the use of either bCBT or iCBT in the remote treatment of OCD.

A Tele-rehabilitation System with an Automated Pegboard Utilizing Radio Frequency Identification

Due to the expense of health care and the need to contain costs, many stroke patients are discharged from hospitals while still in an impaired condition. Using Tele-rehabilitation, these patients can receive rehabilitation services remotely. A pegboard is a conventional rehabilitation therapeutic device that integrates cognition, sensation and hand motor function. This study proposes a Tele-rehabilitation content with automated pegboard and shows its functional feasibility. The evaluation of the pegboard session was automated with RFID (radio frequency identification), and a 16-hole pegboard was rapid-prototyped. After a pegboard session is completed, the session result is uploaded to a server automatically for viewing on a web browser by a remote therapist. The therapist can also send messages to remote patients to encourage them or to manage the rehabilitation process.

The Diagnostic Accuracy of Telerehabilitation for Nonarticular Lower-Limb Musculoskeletal Disorders

Musculoskeletal conditions are highly prevalent and disabling, particularly in rural and remote areas. In these areas, access to rehabilitation services is limited by the availability of physical therapists. Telerehabilitation may be a feasible solution to the issue of rural physical therapy service access; however, there is little existing evidence for clinical efficacy. The aim of this study was to establish the criterion validity and reliability of remote physical assessment and diagnosis of nonarticular lower limb musculoskeletal conditions via telerehabilitation. Nineteen participants with existing nonarticular lower limb musculoskeletal conditions were assessed by a face-to-face therapist and a remote therapist to establish criterion validity of telerehabilitation. Video recordings from the telerehabilitation session were reviewed after 1 month by the remote therapist to establish intrarater reliability and by a second remote therapist to establish interrater reliability. Patho-anatomical diagnoses, system diagnoses, and the findings of the physical examination were compared statistically. There was 79% or higher primary diagnosis agreement (same or similar diagnoses) and 79% or higher exact system diagnosis agreement for validity, intrarater reliability, and interrater reliability studies. The physical examination findings showed substantial agreement (0.61 < kappa < 0.80) in the validity study and almost perfect agreement (0.81 < kappa < 1.00) in the intrarater and interrater reliability studies. Using telerehabilitation for musculoskeletal physical therapy assessment of nonarticular lower limb conditions was found to be valid and reliable. Existing diagnostic reasoning can be applied; however, new methods of patient self-examination are needed to enable differential diagnosis.

Toward the Design of a Wearable System for Fall-Risk Detection in Telerehabilitation

Telemedicine represents a valid aid in rehabilitation process. A remote therapist in a telerehabilitation program could monitor daily motion activity and assign motion-rehabilitation tools on the basis of the fall risk. However, one problem is detection of the fall risk itself. Web-based video-camera images alone do not help the remote assessment of the fall risk using the most commonly used qualitative tests based on visual observation. A novel wearable system to assess fall risk in telerehabilitation has been proposed based on an Inertial Measurement Unit and a medical protocol. It provides a score in four levels (1: no fall risk; 4: major fall risk). The telemedicine tool is integrated to the Global System for Mobile communication (GSM) net. Each component of the wearable system has been designed and integrated. Each component in the system has been tested individually and in a closed loop. One subject was monitored in a telemedicine link. The test showed a high degree of acceptance. The tool will be furnished to subjects along with a homecare device for daily routine monitoring of motion activity and could eventually be integrated with other systems designed to monitor other physiological parameters along with different aids and monitoring tools.

A Virtual Reality—Based Exercise System for Hand Rehabilitation Post-Stroke

This paper presents preliminary results from a virtual reality (VR)-based system for hand rehabilitation that uses a CyberGlove and a Rutgers Master II-ND haptic glove. This computerized system trains finger range of motion, finger flexion speed, independence of finger motion, and finger strength using specific VR simulation exercises. A remote Web-based monitoring station was developed to allow telerehabilitation interventions. The remote therapist observes simplified versions of the patient exercises that are updated in real time. Patient data is stored transparently in an Oracle database, which is also Web accessible through a portal GUI. Thus the remote therapist or attending physician can graph exercise outcomes and thus evaluate patient outcomes at a distance. Data from the VR simulations is complemented by clinical measurements of hand function and strength. Eight chronic post-stroke subjects participated in a pilot study of the above system. In keeping with variability in both their lesion size and site and in their initial upper extremity function, each subject showed improvement on a unique combination of movement parameters in VR training. Importantly, these improvements transferred to gains on clinical tests, as well as to significant reductions in task-completion times for the prehension of real objects. These results are indicative of the potential feasibility of this exercise system for rehabilitation in patients with hand dysfunction resulting from neurological impairment.

A review of Clinical Terms Version 3 (Read Codes) for speech and language record keeping

AbstractThere may be bugs, there may be viruses, but computers are here to stay. Access to computers may vary greatly from ‘seen one once’ to daily usage. However, with an increasing dependence on electronic records, even the most remote therapist will ultimately be faced with computerization. To make this process as painless as possible some commonality in approach is logical. A common vocabulary, for instance, would ensure that dysphasia in Cape Town is the same as dysphasia in Dundee. This is great in theory but is Clinical Terms Version 3 (Read Codes) (CTV3) sufficient to encode records in clinical practice? It is to this end that the Speech and Language Therapy Department at Burton Hospital took part in a multidisciplinary project with the NHS Centre for Coding and Classification (NHS CCC). (NHS CCC became the NHS Information Authority, Coding and Classification on 1 April 1999.) Their CTV3 offers a standardized clinical terminology. An audit of patient case‐notes found that 78% of the terms used by therapists were available in CTV3. Although there are many issues raised concerning electronic patient records, CTV3 presented as a potential vocabulary for recording patient information in this acute setting.

A review of Clinical Terms Version 3 (Read Codes) for speech and language record keeping.

There may be bugs, there may be viruses, but computers are here to stay. Access to computers may vary greatly from 'seen one once' to daily usage. However, with an increasing dependence on electronic records, even the most remote therapist will ultimately be faced with computerization. To make this process as painless as possible some commonality in approach is logical. A common vocabulary, for instance, would ensure that dysphasia in Cape Town is the same as dysphasia in Dundee. This is great in theory but is Clinical Terms Version 3 (Read Codes) (CTV3) sufficient to encode records in clinical practice? It is to this end that the Speech and Language Therapy Department at Burton Hospital took part in a multidisciplinary project with the NHS Centre for Coding and Classification (NHS CCC). (NHS CCC became the NHS Information Authority, Coding and Classification on 1 April 1999.) Their CTV3 offers a standardized clinical terminology. An audit of patient case-notes found that 78% of the terms used by therapists were available in CTV3. Although there are many issues raised concerning electronic patient records, CTV3 presented as a potential vocabulary for recording patient information in this acute setting.