Telerehabilitation System Research Articles

Interactive IIoT-Based 5DOF Robotic Arm for Upper Limb Telerehabilitation

Significant advancements in contemporary telemedicine applications enforce the demand for effective and intuitive telerehabilitation tools. Telerehabilitation can minimize the distance, travel burden, and costs between rehabilitative patients and therapists. This research introduces an interactive novel telerehabilitation system that integrates the Industrial Internet of Things (IIoT) platform with a robotic manipulator named xARm-5, aiming to deliver rehabilitation therapies to individuals with upper limb dysfunctions. With the proposed system, a therapist can provide upper limb rehab exercises remotely using an augmented reality (AR) user interface (UI) developed using Vuforia Studio, which transmits bidirectional data through the IIoT platform. The proposed system has a stable communication architecture and low teleoperation latency. Experimental results revealed that with the developed telerehabilitation framework, the xArm-5 could be teleoperated from the developed AR platform and/or use a joystick to provide standard upper limb rehab exercises. Besides, with the designed AR-based UI, a therapist can monitor rehab/robot trajectories along with the AR digital twin of the robot, ensuring that the robot is providing passive therapy for shoulder and elbow movements.

Telerehabilitation system construction: design of a comprehensive rehabilitation training assessment software

During the COVID-19 pandemic, people in lockdown areas are unable to go to hospitals or rehabilitation institutions for face-to-face rehabilitation treatment, which also brings more inconvenience to people in remote and developing countries. The telerehabilitation is a good solution. As the core of rehabilitation treatment, the degree of informationization of the rehabilitation assessment directly determines the efficiency of telerehabilitation treatment. This paper proposes a telerehabilitation assessment software based on the C/S architecture, which can complete six different rehabilitation assessment schemes (including Manual Muscle Test, Berg Balance Scale, Barthel Index, Functional Independent Measure, Boston Diagnostic Aphasia Examination and Hamilton Depression Scale) to further develop patient-centred and home-based telerehabilitation programmes.

A randomized controlled clinical trial of cardiac telerehabilitation with a prolonged mobile care monitoring strategy after an acute coronary syndrome.

BackgroundCenter‐based cardiac rehabilitation (CBCR) improves health outcomes but has some limitations. We designed and validated a telerehabilitation system to overcome these barriers.MethodsWe included 67 low‐risk acute coronary syndrome patients in a randomized controlled trial allocated 1:1 to a 10‐month cardiac telerehabilitation (CTR) program or an 8‐week CBCR program. Patients underwent ergospirometry, blood tests, anthropometric measurements, IPAQ, PREDIMED, HADS, and EQ‐5D questionnaires at baseline and 10 months. Data collectors were blinded to the treatment groups.ResultsThe intention‐to‐treat analysis included 31 patients in the CTR group and 28 patients in the CBCR group. The primary outcome showed increased physical activity according to the IPAQ survey in the CTR group compared to the CBCR group (median increase 1726 METS‐min/week vs. 636, p = .045). Mean VO2max increased 1.62 ml/(kg min) (95% confidence interval [CI]: 0.56–2.69, p < .004) from baseline in the CTR group, and 0.60 mL/(kg min) (p = .40) in the CBCR group. Mean apoB/apoA‐I ratio decreased 0.13 (95% CI: −0.03 to 0.24, p = .017) in the CTR group, with no significant change in the CBCR group (p = .092). The median non‐HDL cholesterol increased by 7.3 mg/dl (IQR: −2.4 to 18.6, p = .021) in the CBCR group, but the increase was not significant in the CTR group (p = .080). Adherence to a Mediterranean diet, psychological distress, and quality of life showed greater improvement in the CTR group than in the CBCR group. Return‐to‐work time was reduced with the telerehabilitation strategy.ConclusionThis system allows minimal in‐hospital training and prolonged follow‐up. This strategy showed better results than CBCR.

Feasibility, Satisfaction With, and Attitude Toward Telerehabilitation During COVID-19 Pandemic: Experience of Iranian Rehabilitation Professionals

Objectives: COVID-19 pandemic and its consequences highlighted the importance of using telerehabilitation systems and affected the professional’s attitude toward it. This study aimed to investigate the feasibility, satisfaction, and attitude of rehabilitation professionals toward telerehabilitation during the COVID-19 pandemic in Iran. Methods: A web-based cross-sectional study was conducted to assess the feasibility, satisfaction, and attitude of rehabilitation professionals toward virtual training and telerehabilitation during the COVID-19 pandemic. A total of 118 occupational therapists, speech therapists, audiologists, psychologists, and educators completed the study questionnaires. Results: The findings indicate that the correlations among satisfaction, feasibility, advantages, and compatibility were significant (r ranging from 0.418 to 0.717). There were significant but weak positive correlations between years of working experience and scores of feasibility and advantages. In addition, the mean scores of feasibility, advantages, compatibility, and complexity in participants who provided telerehabilitation before the COVID-19 pandemic were higher than other respondents. Discussion: Because of the positive role of telerehabilitation in a situation such as the COVID-19 pandemic, health care systems should create mechanisms for its optimal use, protocol preparation, health professionals training, and infrastructure acquisition.

Effects of home-based virtual reality telerehabilitation system in people with multiple sclerosis: A randomized controlled trial

Background and objective Multiple sclerosis is an inflammatory and neurodegenerative disorder of the central nervous system that can lead to severe motor disability. The aim of this study was to verify the health care effects of an integrated telerehabilitation approach involving dual-domains (motor and cognitive) in people with multiple sclerosis using a virtual reality rehabilitation system compared to a home-based conventional rehabilitative intervention usual care for patient-relevant outcomes (motor, cognitive and participation). Methods This multicentre interventional, randomized controlled trial included 70 participants with multiple sclerosis, 35 in the telerehabilitation group (30 sessions of home-based virtual reality rehabilitation system training, five sessions for week each lasting 45 min) and 35 in the usual care group (30 sessions of conventional treatment, five sessions for week). Participants completed the assessment of motor, cognitive and participation outcomes at baseline and after 6 weeks of treatment. Results In total, 63.3% of the telerehabilitation group exhibited improvement in the physical domain of the quality of life (p = 0.045). The telerehabilitation group showed greater improvement than the usual care group in Mini-BESTest domains of balance (p = 0.014), postural control (p = 0.024), and dynamic walking (p = 0.020) at post-treatment. Higher adherence was registered for telerehabilitation compared with usual care (86.67% vs. 80.0%). Discussion This study provides evidence that people with multiple sclerosis can benefit from telerehabilitation treatment in the physical domain of the quality of life and motor symptoms. Moreover, considering the persistent COVID-19 emergency, telerehabilitation can represent an effective telemedicine solution for safely delivering effective rehabilitation care to people with multiple sclerosis. Trial registration number and trial register This trial was registered at ClinicalTrials.gov (NCT03444454).

Feasibility, Acceptability and Limitations of Speech and Language Telerehabilitation during COVID-19 Lockdown: A Qualitative Research Study on Clinicians’ Perspectives

The COVID-19 pandemic brought out the need to deliver health care services at a distance in the form of telerehabilitation (TR). This study aimed to analyse the Italian speech and language therapists’ (SLTs) opinions on the feasibility of the TR in the field of speech-language therapy during the COVID-19 pandemic. We developed an anonymous survey to determine the SLTs’ opinions on feasibility of TR during lockdown caused by COVID-19. We analysed the survey’s answers provided by 136 SLTs. Cronbach’s alpha coefficient showed good reliability of the survey. The SLTs working previously with TR showed better judgements regarding this method. The comparison analysis between TR and face-to-face treatment delivery showed statistically significant differences as follows: “importance” (4.35 vs. 3.32, p = 0.001), “feasibility” (3.37 vs. 2.11, p < 0.001), “alternative form” (3.64 vs. 2.58, p = 0.001) and “comparison” (2.24 vs. 1.69, p < 0.001), but not with “familiarity” (p = 0.81). The survey showed that most of the Italian SLTs were not satisfied with TR systems. SLTs who used TR previously had a better opinion on this treatment modality. Experience and familiarity with TR systems were key factors for the use of this new rehabilitation modality.

A comprehensive evaluation of state-of-the-art time-series deep learning models for activity-recognition in post-stroke rehabilitation assessment.

The recent COVID-19 pandemic has further high-lighted the need for improving tele-rehabilitation systems. One of the common methods is to use wearable sensors for monitoring patients and intelligent algorithms for accurate and objective assessments. An important part of this work is to develop an efficient evaluation algorithm that provides a high-precision activity recognition rate. In this paper, we have investigated sixteen state-of-the-art time-series deep learning algorithms with four different architectures: eight convolutional neural networks configurations, six recurrent neural networks, a combination of the two and finally a wavelet-based neural network. Additionally, data from different sensors' combinations and placements as well as different pre-processing algorithms were explored to determine the optimal configuration for achieving the best performance. Our results show that the XceptionTime CNN architecture is the best performing algorithm with normalised data. Moreover, we found out that sensor placement is the most important attribute to improve the accuracy of the system, applying the algorithm on data from sensors placed on the waist achieved a maximum of 42% accuracy while the sensors placed on the hand achieved 84%. Consequently, compared to current results on the same dataset for different classification categories, this approach improved the existing state of the art accuracy from 79% to 84%, and from 80% to 90% respectively.

Exploring the Acceptability and Feasibility of Providing a Balance Tele-Rehabilitation Programme to Older Adults at Risk for Falls: An Initial Assessment.

Falls are a major health concern. The HOLOBALANCE tele-rehabilitation system was developed to deliver an evidence based, multi-sensory balance rehabilitation programme, to the elderly at risk of falls. The system delivers a series of balance physiotherapy exercises and cognitive and auditory training tasks prescribed by an expert balance physiotherapist following an initial balance assessment. The HOLOBALANCE system uses augmented reality (AR) to deliver exercises and games, and records task performance via a combination of body worn sensors and a depth camera. The HOLOBALANCE tele-rehabilitation system provides feedback to the supervising clinical team regarding task performance, participant usage and user feedback. Herewith we present the findings from the first 25 study participants regarding the feasibility and acceptability of the proposed system. The results of the clinical study indicate that the system is acceptable by the end users and also feasible for using in hospital and home environments.

Percepción sobre las atenciones de terapia ocupacional en modalidad de telerrehabilitación en pacientes atendidos en la sección de Terapia Ocupacional del Hospital del Trabajador, Santiago de Chile

Hospital del Trabajador is part of the biggest workers compensation system in Chile, it provides care for workers who suffered job related accidents or occupational diseases. Occupational Therapy delivers rehabilitation interventions through a comprehensive and functional perspective in order to facilitate personal autonomy, job reintegration and social participation of its users. Prior to this contingency, services were delivered 100% on site, but with the arrival of COVID-19, the mobility of people was limited through the implementation of quarantines, preventing or hindering participation in face-to-face treatment sessions. To guarantee the continuity of the treatments, a care protocol was designed with a tele-rehabilitation system, where each area designed activities that were possible to be replicated at the users' homes. Given how untimely and fast these changes happened, it was considered important to carry out a self-evaluation within the occupational therapy team three months after implementing the system, carrying out a descriptive study that seeks to know the perceived advantages and disadvantages of the system. The main conclusions show that this modality is highly beneficial to maintain the continuity of treatment at home, being even more productive when combined with face-to-face activities, where tele-rehabilitation modality reinforce activities carried out directly. The main disadvantage is the need for the user to have access and use of technology that allows daily connection or, otherwise, to have supportive networks to facilitate the process.

Development of a Tele-Rehabilitation System Using an Upper Limb Assistive Device

A tele-rehabilitation system that can achieve remote interaction between a physical therapist (PT) and a patient was developed. Patients need to execute rehabilitation exercises to maintain upper limb function. However, it is difficult for them to travel to hospitals without aid. This system is equipped with a PC and a Kinect sensor at the hospital side (i.e., the PT), and a PC and an upper limb assistive device in the patient’s home. The PT displays the motion in front of a Kinect sensor, which identifies the motion. In addition, the device on the home side assists the motion of the patient using the Internet. When the device receives a force higher than the safety value from the patient at any particular point on it, vibrators at the corresponding point on the PT’s arm start to vibrate. Thereby, the PT can identify the patient’s condition and limitations. The time delays in the transmission of data of device motion and the vibrators were measured and compared. As a result, the PT could identify the patient’s condition faster than the motion of the device.

Tele-Rehabilitation Systems for Empowering Parents and Their Children with Disabilities in India - A SWOT Analysis of the Context for Implementation.

Persons with Disabilities (PWD) experience unmet needs related to health, rehabilitation, education, livelihood, social participation, and empowerment, particularly those living in a resource-poor context such as in the Indian context. The same applies to Children with Disabilities (CWD) as well. Given the pandemic restrictions imposed by the government of India, the provision of therapeutic rehabilitation services for PWDs and CWDs has come to a deadlock. Therefore, the PWDs and the parents of CWDs are substantially impacted by the double contextual burden of demand and access to rehabilitation services in India. However, there has been some light at the end of this dark tunnel provided by the existing telecommunication strategies. Both parents/caregivers and rehabilitation service providers started to find a way out of this situation on their own in India by optimizing their skills and resources for telerehabilitation. However, adopting this strategy requires evidence. Hence a critical Strengths Weaknesses Opportunities and Threats (SWOT) analysis of the telerehabilitation strategy for empowering PWDs and CWDs in an Indian context is warranted and is of immense public health importance. A narrative review was conducted.Telerehabilitation has several strengths, weaknesses, opportunities, and threats. Telecommunication resources, Access to Rehabilitation services, Parent’s and consumer acceptance, Service efficiency, and data documentation could be considered as strengths; Skills, Competencies, Opportunity cost, Resource intensiveness, Evidence for Effectiveness, Comprehensibility could be considered as weaknesses; Therapy innovations, Evidence generation, System strengthening and Capacity Building could be considered as opportunities; Patient Safety, Ethical Integrity, Data security, and Professional practice insecurity could be considered as potential Threats to Telerehabilitation. Telerehabilitation has considerable scope for providing meaningful therapeutic experience and hastens the process of rehabilitation of CWDs in the current context. The SWOT and its implications must be kept in mind to ensure that CWDs receive the best quality continuum of care in the present context with utmost ethical and evidence-based considerations. This could bridge the gaps in access to rehabilitation services with sustainable solutions than patchy temporary solutions that are not sustainable.

Telerehabilitación en alta latitud sur. Resultados de una implementación de tratamiento para personas en situación de discapacidad durante la pandemia de COVID-19

The health situation after the emergence of COVID-19 has precipitated the use of new technologies and the adaptation of rehabilitation services of all kinds. ObjectiveTo describe the implementation of a telerehabilitation system in patients with different diagnoses of disability living in the high southern latitude during the COVID-19 pandemic. MethodsA system of personalized therapies guided by videoconference was implemented for patients with varying diagnoses of disability. The patients were grouped into three age groups (Minors; Adults; Older Adults) and six types of clinical diagnosis (conditions originating in the perinatal period, diseases of the circulatory system, diseases of the nervous system, diseases of the musculoskeletal system, and connective tissue, mental and behavioural treatments and other diagnoses). The patient's diagnosis, the type of care required, the number of sessions, and the level of satisfaction of each user were evaluated based on the telerehabilitation they received. Results101 patients with an average age of 31±26 years participated, 52.5% were male. All of them managed to handle the minimum technologies required for telerehabilitation care. There is a degree of association between the patient's diagnosis and the age group (p<.05), as well as between the diagnosis and the type of care required (p<.05). After implementation, users positively evaluated distance therapy. ConclusionsTelerehabilitation can be implemented in patients with disabilities in areas of high southern latitude, respecting the different stages of the process, to ensure it is correctly delivered.

Feasibility and effect of interactive telerehabilitation on balance in individuals with chronic stroke: a pilot study

BackgroundStroke survivors need continuing exercise intervention to maintain functional status. This study assessed the feasibility and efficacy of an interactive telerehabilitation exergaming system to improve balance in individuals with chronic stroke, compared to conventional one-on-one rehabilitation.MethodsIn this prospective case–control pilot study, 30 Taiwanese individuals with chronic stroke were enrolled and randomly allocated to an experimental group and a control group. All participants received intervention 3 times per week for 4 weeks in the study hospital. The experiment group underwent telerehabilitation using a Kinect camera-based interactive telerehabilitation system in an independent room to simulate home environment. In contrast, the control group received conventional one-on-one physiotherapy in a dedicated rehabilitation area. The effectiveness of interactive telerehabilitation in improving balance in stroke survivors was evaluated by comparing outcomes between the two groups. The primary outcome was Berg Balance Scale (BBS) scores. Secondary outcomes were performance of the Timed Up and Go (TUG) test, Modified Falls Efficacy Scale, Motricity Index, and Functional Ambulation Category.ResultsComparison of outcomes between experimental and control groups revealed no significant differences between groups at baseline and post-intervention for all outcome measures. However, BBS scores improved significantly in both groups (control group: p = 0.01, effect size = 0.49; experimental group: p = 0.01, effect size = 0.70). Completion times of TUG tests also improved significantly in the experimental group (p = 0.005, effect size = 0.70).ConclusionThe Kinect camera-based interactive telerehabilitation system demonstrates superior or equal efficacy compared to conventional one-on-one physiotherapy for improving balance in individuals with chronic stroke.Trial registration ClinicalTrials.gov. NCT03698357. Registered October 4, 2018, retrospectively registered.

Physiotherapists\u2019 perceptions of and willingness to use telerehabilitation in Kuwait during the COVID-19 pandemic

BackgroundTelerehabilitation has been considered a suitable alternative healthcare delivery system during the COVID-19 outbreak, and many studies have promoted its feasibility in delivering physical care to patients who live with pain and disability. Physiotherapists’ perceptions and willingness are two key factors that influence the provision of remote physiotherapy.AimTo investigate physiotherapists’ perceptions of and willingness to use telerehabilitation in Kuwait during the COVID-19 pandemic and to explore the barriers that may hinder the use of telerehabilitation in this sector.MethodsThe following methods were used: (1) a cross-sectional survey and (2) face-to-face semi-structured interviews. In the cross-sectional survey, an electronic questionnaire was sent to 747 physiotherapists who were working in the governmental health sector. The questionnaire included four sections: perceptions of telerehabilitation, comfort with technology, willingness to use telerehabilitation, and barriers to using telerehabilitation. Six interviews were conducted with physiotherapy managers to explore the barriers and facilitators of telerehabilitation practice.Data analysisIn this study, descriptive data analysis was conducted, and a cross-tabulation technique was used to find the associations between the variables, in which chi-square tests were used to identify the significance of the results, where p < 0.05. Thematic content analysis was used for the interviews.ResultsOnly 273 completed questionnaires were received, giving a response rate of 36.5%. Most of the respondents (237; 86.8%) considered telerehabilitation a viable option to deliver healthcare to patients during the COVID-19 pandemic. In spite of the lack of information and communication technology (ICT) (156; 57.1%), 89% (243) of the respondents were willing to integrate telerehabilitation into their conventional practice, as cultural and social norms were not against the use of telerehabilitation systems. The results indicate that the more the physiotherapists used the internet and email in their work and the more comfortable they were with technology, the more willing they were to use telerehabilitation systems (p = 0.01). The physiotherapy managers reported that patients’ privacy and the confidentiality of their data were considered barriers.ConclusionIn Kuwait, physiotherapists show overall positive perceptions towards and a willingness to use telerehabilitation to facilitate patients’ access to physiotherapy services. There are several barriers to employing telerehabilitation. Accordingly, recommendations are suggested.

Kinect-based integrated physiotherapy mentor application for shoulder damage

With the increasing rate of disabled people in the world, the number of people in need of physiotherapy is increasing. Most of the disabled persons with shoulder damaged should do physiotherapy exercises. The telerehabilitation systems using developed technologies have advantages over conventional physiotherapy methods. Such systems have the potential to improve communication between patients and physiotherapists. They also allow for easier information and medical data sharing. In this study, a telerehabilitation system based on Kinect Sensor (Kinect 2) was developed to observe and evaluate shoulder damaged patient exercises by using the Kinect skeletal monitoring feature. The proposed system consists of two basic components: the web application that enables the communication between patients and physiotherapists, allows the physiotherapist to observe/update patient exercise data, patients information, and the console application which enables the patients to perform their exercises correctly. This console app was developed for patients with shoulder damage. Abduction, flexion, internal rotation, external rotation, extension exercises can be performed correctly thanks to the developed application. The proposed system was evaluated in Bilecik State Hospital for 29 shoulder damaged volunteers. 14 of the volunteers were treated with the conventional methods and 15 of them were treated with the proposed system. The recovery of the volunteers was analyzed for each intragroup and intergroup comparison was made. Statistically, significant decreases were observed in the limitations of the patients treated with the proposed system. For abduction, flexion, internal rotation, and external rotation exercises, the Kinect-based physiotherapy mentor application was more successful than conventional method, while all volunteers treated by the proposed method had no limitations in extension exercise. As a result, the Kinect-based physiotherapy mentor application can be used as an alternative telerehabilitation method for patients with shoulder damaged.

Telerehabilitation During the COVID-19 Pandemic

After the appearance of COVID-19, the clinical and professional activities of private clinics and public health systems were challenged. Tele rehabilitation system is required to provide rehabilitation services during the COVID 19 pandemic. Tele-rehabilitation services are available for many years, for which necessary infrastructure, laws, and instructions have been considered, but in Iran, there are no regulations or instructions for telerehabilitation services. Professional associations and boards can play an important role in drafting these rules. The COVID-19 can be a good opportunity to start telerehabilitation in Iran.

Patient and Parent Experiences with Group Telerehabilitation for Child Survivors of Acute Lymphoblastic Leukemia.

Background: Acute Lymphoblastic Leukemia (ALL) is the most common pediatric cancer. ALL and its treatment cause altered bone-mineral homeostasis, which can contribute to musculoskeletal late adverse effects (LAEs). With the increasing number of childhood cancer survivors, LAEs are reported often, and are aggravated by inactive lifestyles. A telerehabilitation program is proposed to strengthen the muscle–bone complex and prevent future impairment. Objective: This study aimed to explore and better understand patient and parent experience of a telerehabilitation program after completion of ALL treatment. Methods: ALL survivors (n = 12), 75% girls, 7.9 to 14.7 years old, within six months to five years of treatment, were recruited to participate in the proposed study, along with a parent. The 16-week group program included 40 potential home-based physical activities, with monthly progression, supervised by a kinesiologist, through an online telerehabilitation platform. Patients could be included in the study if they joined during the first month of intervention of their group (minimum 12 weeks of intervention). A semi-structured post-intervention interview was conducted with the patients and their parent during the final assessment, along with a review of the kinesiologist’s clinical notes, to obtain a portrait of the participants’ experience with the telerehabilitation program. Overarching themes were identified by one author and confirmed by two senior authors before extracting the various aspects of each theme. Results: Of the 12 patients recruited, three were excluded from the analysis because they did not complete the minimum 12 weeks of intervention (one = relapse, one = failure to meet technical requirements, and one = abandoned due to parent’s disinterest). The nine patients who completed the program (six girls; 10.93 ± 2.83 years) had a mean adherence of 89%. The overarching themes identified were the program modalities (group approach with patient–parent paired training, supervised by a kinesiologist), the telerehabilitation system, the participants’ perception of the benefits, and recommendations and suggestions from the families. Both patients and parents expressed very high satisfaction with the program and perceived benefits. Conclusion: Participants appreciated the program and reported they would all recommend it to other families in similar situations. The telerehabilitation method of service delivery was perceived by some as decisive in choosing to participate, while the supervision and intra- and inter-family interactions were the motivating factors that were key to program adherence.

MRI correlates of cognitive improvement after home-based EEG neurofeedback training in patients with multiple sclerosis: a pilot study

ObjectiveNeurofeedback training may improve cognitive function in patients with neurological disorders. However, the underlying cerebral mechanisms of such improvements are poorly understood. Therefore, we aimed to investigate MRI correlates of cognitive improvement after EEG-based neurofeedback training in patients with MS (pwMS).MethodsFourteen pwMS underwent ten neurofeedback training sessions within 3–4 weeks at home using a tele-rehabilitation system. Half of the pwMS (N = 7, responders) learned to self-regulate sensorimotor rhythm (SMR, 12–15 Hz) by visual feedback and improved cognitively after training, whereas the remainder (non-responders, n = 7) did not. Diffusion-tensor imaging and resting-state fMRI of the brain was performed before and after training. We analyzed fractional anisotropy (FA) and functional connectivity (FC) of the default-mode, sensorimotor (SMN) and salience network (SAL).ResultsAt baseline, responders and non-responders were comparable regarding sex, age, education, disease duration, physical and cognitive impairment, and MRI parameters. After training, compared to non-responders, responders showed increased FA and FC within the SAL and SMN. Cognitive improvement correlated with increased FC in SAL and a correlation trend with increased FA was observed.ConclusionsThis exploratory study suggests that successful neurofeedback training may not only lead to cognitive improvement, but also to increases in brain microstructure and functional connectivity.

Exergaming as Part of the Telerehabilitation Can Be Adequate to the Outpatient Training: Preliminary Findings of a Non-randomized Pilot Study in Parkinson's Disease.

Parkinson's disease is a long-term and progressive degenerative disorder of the nervous system, affecting primarily motor coordination, noticeable as a tremor in one hand. Recent studies reported on positive outcomes of intensive physiotherapy of upper extremities. We built a telerehabilitation system with virtual pick and place tasks for small scale hand movements, and designed a pilot study to find whether such exergaming as a telerehabilitation service provides comparable outcomes as an outpatient exergaming service. A non-randomized pilot trial was designed. Hospital outpatients (28/40) with Parkinson's disease were recruited. Those meeting the inclusion criteria were divided into two groups; seven outpatients were assigned to the home (H) group and 21 outpatients to the hospital (URI) group. Both groups received 10 days of exergaming over the course of 2 weeks, each daily session lasting a maximum of 1 h. Primary outcomes were clinical tests; Box and Blocks Test (BBT), Jebsen Hand Function Test (JHFT), and Unified Parkinson's Disease Rating Scale (UPDRS part III) were carried out before and after the study. Secondary outcomes were hand kinematics and exergaming results; number of successfully moved objects and task time. Statistical analysis was carried out to find significant (p < 0.05) differences and Cohen's U3 was used to determine effect sizes. The differences between the groups in gender (p = 0.781), age (p = 0.192), and duration of the disease (p = 0.195) were tested with Bartlett's test and no statistical differences were found with an F test. Both groups demonstrated statistically significant improvements in clinical test UDPRS III (p = 0.006 and p = 0.011) and the hospital group also in BBT (p = 0.002) and JHFT (p = 0.015) and with UDPRS III and JHFT even in favor of the home group (χ2 = 5.08, p = 0.024, χ2 = 7.76, p = 0.005). Nevertheless, the exergaming results show significant improvement after training (U3 > 0.86). Exergaming has already been suggested as an effective approach in the planning of rehabilitation tasks for persons with Parkinson's disease. We have prepared a pilot study demonstrating that exergaming at home with telerehabilitation support may provide comparable clinical outcomes. The study shall be followed by a randomized study with higher statistical power to provide clinical evidence. Nevertheless, carrying out even part of the rehabilitation program at home is crucial for the development of future telerehabilition clinical services.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03175107.

A Low-Cost Telerehabilitation Paradigm for Bimanual Training

The COVID-19 pandemic has transformed daily life, as individuals must reduce contacts among each other to prevent the spread of the disease. Consequently, patients&#x2019; access to outpatient rehabilitation care was curtailed and their prospect for recovery has been compromised. Telerehabilitation has the potential to provide these patients with equally efficacious therapy in their homes. Using commercial gaming devices with embedded motion sensors, data on movement can be collected toward objective assessment of motor performance, followed by training and documentation of progress. Herein, we present a low-cost telerehabilitation system dedicated to bimanual exercise, wherein the healthy arm drives movements of the affected arm. In the proposed setting, a patient manipulates a dowel embedded with a sensor in front of a Microsoft Kinect sensor. In order to provide an engaging environment for the exercise, the dowel is interfaced with a personal computer, to serve as a controller. The patient&#x2019;s gestures are translated into actions in a custom-made citizen-science project. Along with the system, we introduce an algorithm for classification of the bimanual movements, whose inner workings are detailed in terms of the procedures performed for dimensionality reduction, feature extraction, and movement classification. We demonstrate the feasibility of our system on eight healthy subjects, offering support to the validity of the algorithm. These preliminary findings set forth the development of precise motion analysis algorithms in affordable home-based rehabilitation.