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Telerehabilitation Approach for Patients with Hand Impairment

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Telerehabilitation Approach for Patients with Hand Impairment Acta of Bioengineering and Biomechanics Original paper Vol. 18, No. 4, 2016 DOI: 10.5277/ABB-00428-2015-03 Telerehabilitation approach for patients with hand impairment ARLETA STASZUK1, BENITA WIATRAK2*, RYSZARD TADEUSIEWICZ1, EWA KARUGA-KUŹNIEWSKA3, ZBIGNIEW RYBAK4 1 Faculty of Electrical Engineering, Automatics, Computer Science and Biomedical Engineering, AGH University of Science and Technology, Kraków, Poland. 2 Department of Basic Medical Sciences, Wrocław Medical University, Poland. 3 Division of Infectious Diseases of Animals and Veterinary Administration, Department of Epizootiology and Clinic of Bird and Exotic Animals, Wrocław University of Environmental and Life Sciences, Poland. 4 Department of Experimental Surgery and Biomaterials Research, Wrocław Medical University, Poland. Purpose: Telerehabilitation is one of the newest branches of telemedicine which has been developed because patients need regular trainings outside the medical institution but still under specialist supervision. It helps maintain regularity of exercises and reduces costs. The professional and advanced systems for telerehabilitation are presented in papers, however, there is still lack of development of minor systems which provide therapeutic values and are more accessible to people. Therefore we focus on a solution for hand telerehabilitation of post- stroke patients, based solely on a personal computer and camera. Methods: We focused on the manipulative hand (fingers, metacarpus, wrist) movements trainings for patients with cerebral palsy. The contact between patient and physiotherapist is provided by using web cameras and web service. Additionally, the camera can be used to monitor the effectiveness of performed exercises. Computer vision system keeps track of the patient’s hand movement. The digital image processing is used to detect if the patient performs exercises correctly. Results: We cre- ated web service and software application TeleReh that provides therapeutic values for the hand impaired people. The system created was evaluated by three physiotherapists, one doctor and a cerebral palsy patient. Conclusions: Our solution applies to all patients who have un- dergone basic rehabilitation in hospital and need to continue hand rehabilitation at home. The main advantages are: easy adaptation to the individual needs and abilities, monitoring the progress by using automatically generated reports after each training session. It is worth notic- ing that discussion between IT specialists, rehabilitants and patients was necessary to achieve good results. Key words: stroke, telemedicine, telerehabilitation 1. Introduction ologists, surgeons) [22], [23]. Most of the existing telemedical equipment finds its application in render- ing diagnosis [20], [25]. An important goal of tele- Telemedicine can be considered as an area of medicine is permanent and ubiquitous monitoring of practical activities (both technological and medical) the patient’s health [2], [9], [16]. Due to the strained and a new way of providing healthcare services. De- financial situation in the healthcare sector, hospitals velopment of telemedicine systems can only be possi- and other healthcare providers are facing an increas- ble with the collaboration and support of experts from ing pressure to improve their efficiency and reduce technical specializations (such as telecommunication, costs. These trends motivate healthcare organizations information technology, biomedical engineering, auto- to introduce innovative information technology (IT) matic control, robotics) and medical sciences (such as based supportive processes [13], [25]. It means that doctors, physiotherapists, laboratory technicians, radi- telemedicine, as a more economical way of providing ______________________________ * Corresponding author: Benita Wiatrak, Department of Basic Medical Sciences, Wrocław Medical University, ul. Borowska 211, 50-556 Wrocław, Poland. Tel: 667 398 821, e-mail: [email protected] Received: July 21st, 2015 Accepted for publication: January 13th, 2016 56 A. STASZUK et al. healthcare services, should be used for therapeutic 1.1. Existing solutions purposes [18]. Providing medical services at a dis- for hand telerehabilitation tance is a challenge for system developers and future users – patients. Patients should also participate in creating telemedical system because only they can Frequently, the hand rehabilitation is supported by specify the system usability requirements. Of course, additional devices. Most manipulators support passive not every treatment can be carried out by means of movement, but it is noted that it does not provide ex- telemedical facilities, but in certain cases it is safe, pected results of strengthened limbs, because the effective and comfortable [14]. movement is performed by device, not a patient. The This paper covers particular subarea of telemedicine devices equipped with electromyography sensors – IT applications in telerehabilitation. The area of telere- measure the patient’s force and support active move- habilitation is still “a promised land” for biomedical ment. A specialized telemanipulators for hand telere- engineers, IT specialists, medical doctors and the pa- habilitation can also be used during the treatment [26]. tients. This paper deals exactly with this issue. Telereha- The rehabilitant uses the master device for controlling bilitation provides rehabilitation services at a distance the patient’s device mounted on the hand [12], [19]. and applies to all patients who were first rehabilitated in The process of rehabilitation becomes more interest- hospital and need to continue their rehabilitation at home ing and motivating when games, Virtual Reality, or [4], [15]. It has a great potential for reducing the costs of Augumented Reality are used [1], [6], [15]. The exer- healthcare delivery for people who live in villages far cises could be presented as games and such games from big cities. Most of them are not able to come to could include movements from daily activities. a rehabilitation center due to various deformities or dis- It can be observed that there is still lack of minor abilities, but can do the exercises at home under special- applications which still provide therapeutic values but ist’s supervision at a distance. are more accessible to people, without the necessity of Telerehabilitation merge medical and technical purchasing additional specialized devices. In this pa- sciences and is developed mainly by biomedical engi- per, such a solution is presented. neers, programmers and rehabilitants. Therefore two types of publications databases were investigated. In 1.2. Typical disorders the IEEE Xplore Digital Library, which contains sci- entific and technical content, there are over one hun- which can be treated dred articles concerning telerehabilitation. In the by means of telerehabilitation PubMed digital library, one can find biomedical lit- erature, of which more than 250 papers are related to Telerehabilitation can transfer some parts of the telerehabilitaion. Figure 1 shows that over the last therapy from hospital to the patient’s home. But not 20 years interest in the “telerehabilitation” subject has all patients can be treated this way, because epilepsy, grown. Selected results of research, which can be spasticity, sensory impairment, cognitive and conscious- found in publications from the two databases, are pre- ness disorders can limit the use of equipment and sented in this article. telerehabilitation systems. The possibility of practical application of remote rehabilitation depends on the type and severity of the disease. It is helpful for pa- tients who have life-long rehabilitation needs, like patients after bone fractures, patients with degenera- tive joint disease and neurological diseases such as stroke, polyneuropathy and spine cord injuries. Stroke is a type of cardiovascular disease affecting the arteries within the brain or leading to the brain. Ischemia (caused by blockage at about 85% of all strokes) or a hemorrhage damages the brain and there- “Telerehabilitation” in PubMed fore a part of the body does not work as it should. “Telerehabilitation” in IEEE Explore Digital Stroke appears suddenly and affects a large group of Library people. Every year, about 70,000 people in Poland Fig. 1. Number of articles related to “telerehabilitation” keyword and more than 795,000 people in the United States in two digital libraries – PubMed and IEEE Xplore Digital Library, have a stroke. Stroke causes long-term disabilities and 1995–2015 leads to the lack of independence. Additionally, the Telerehabilitation approach for patients with hand impairment 57 impact on the national economy is noticeable. In the healthcare the medical images (registered by Magnetic United States an estimated total cost of patients after Resonance, Computer Tomography, Ultrasonography) stroke is $36.5 billion each year and includes care with diagnosis are stored in the database. It is worth services, medications to treat stroke, and missed days mentioning that specialists and users are permitted to of work [8]. Another disease – osteoarthritis (degen- access selected data related to their needs. Optionally erative joint disease) also occurs frequently and af- Smartphones, tablets or smartwatches (Fig. 2D) can fects about 8 million people in Poland. Recent studies be used. The data collected by the devices equipped have shown that repetitive and continuous training is with sensors can also be stored in the central database, necessary to
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