Web-based telerehabilitation for the upper extremity after stroke

The Rutgers Arm, a Rehabilitation System in Virtual Reality: A Pilot Study

Stroke is one of the leading causes of death and disability worldwide. Its prevalence calls for innovative rehabilitation methods. The Rutgers Arm is a novel upper extremity rehabilitation system consisting of a low-friction table, three-dimensional (3D) tracker, custom forearm support, PC workstation, library of Java 3D virtual reality (VR) exercises, clinical database module, and a tele-rehabilitation extension. The system was tested on a chronic stroke subject, under local and tele-rehabilitation conditions, over 5 weeks of training. Results show improvements in arm motor control and shoulder range of motion, corresponding to improved Fugl-Meyer test scores. Exercise duration, level of difficulty, and patient motivation were maintained under tele-rehabilitaion. A 1-week retention trial showed that gains were maintained.

Enhancement of motor rehabilitation through the use of information technologies

The recent development of information technologies has dramatically increased the tools available for facilitating motor rehabilitation. This review focuses on technologies which can be used to augment movement-related information both to patients as well as to their therapists. A brief outline of the motor system emphasizes the role of spinal motor neurons in the control of voluntary movement and rehabilitative efforts. Technologies which induce passive motion to stimulate spinal motor output as well as technologies that stimulate active voluntary movements are discussed. Finally, we review technologies and notational methods that can be used to quantify and assess the quality of movement for evaluating the efficacy of motor rehabilitation efforts. We conclude that stronger evidence is necessary to determine the applicability of the wide range of technologies now available to clinical rehabilitation efforts.

An Evaluation Framework for a Rural Home-Based Telerehabilitation Network

This study was a needs assessment to inform the design and evaluation of a home-based telerehabilitation network for rural elderly patients. We conducted a literature review of telerehabilitation studies and a needs-assessment by interviewing 43 professionals, including homecare nursing staff, members of volunteer organizations and service agencies, social workers, discharge planners, researchers, and rehabilitation therapists. The survey addressed perceived needs, advantages, and disadvantages with the use of telemedicine technologies for rehabilitation services. All respondents agreed that there are unmet needs among elderly people who are discharged from hospital settings, and identified several problems including: medication noncompliance, isolation, limited access to specialists and community-based services. Our findings defined a framework for the development of a client-oriented rural telehealth network that will be used to guide patients discharged to homecare following stroke, through a complex array of health, mental health, and social services, spanning all levels of care.

Virtual environments for motor rehabilitation: review

In this paper, the current "state of the art" for virtual reality (VR) applications in the field of motor rehabilitation is reviewed. The paper begins with a brief overview of available equipment options. Next, a discussion of the scientific rationale for use of VR in motor rehabilitation is provided. Finally, the major portion of the paper describes the various VR systems that have been developed for use with patients, and the results of clinical studies reported to date in the literature. Areas covered include stroke rehabilitation (upper and lower extremity training, spatial and perceptual-motor training), acquired brain injury, Parkinson's disease, orthopedic rehabilitation, balance training, wheelchair mobility and functional activities of daily living training, and the newly developing field of telerehabilitation. Four major findings emerge from these studies: (1) people with disabilities appear capable of motor learning within virtual environments; (2) movements learned by people with disabilities in VR transfer to real world equivalent motor tasks in most cases, and in some cases even generalize to other untrained tasks; (3) in the few studies (n = 5) that have compared motor learning in real versus virtual environments, some advantage for VR training has been found in all cases; and (4) no occurrences of cybersickness in impaired populations have been reported to date in experiments where VR has been used to train motor abilities.

Low-bandwidth telerehabilitation for patients who have undergone total knee replacement: preliminary results

We have developed a low-bandwidth, Internet-based telerehabilitation system to provide outpatient rehabilitation to patients who have undergone total knee arthroplasty. The preliminary efficacy of this treatment programme in terms of both physical and functional objective outcome measures was assessed on 21 patients. Subjects receiving a six-week rehabilitation programme were randomized to the telerehabilitation system or the usual face-to-face method. The physical and functional improvements in the telerehabilitation group were similar to those in the control group. There was a non-significant trend for greater improvements in the telerehabilitation group for most outcome measurements. The telerehabilitation programme was well received by patients. The results of this study provide evidence for the efficacy of low-bandwidth telerehabilitation consultations.