Post-Stroke
Telerehabilitation
Christopher Golby
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Structure
• Stroke
• Rehabilitation of Stroke
• Telerehabilitation
• Assessment through
Telerehabilitation
• Conclusion
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Introduction
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Stroke – The Facts
Worldwide per year[1]:
• 15 Million Will Suffer a Stroke
• 5 Million Will Result in Fatality
• 5 Million will be left with a long
term disability
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Stroke – The Facts
• Stroke is Australia’s second single greatest killer[2].
•
In 2011, Australians will suffer around 60,000 new and
recurrent strokes – that’s one stroke every 10 minutes[3].
•
The ageing population is causing the incidence of stroke
to increase each year[5].
• About 88 per cent of stroke survivors live at home and
most have a disability[6].
•
Strokes cost Australia an estimated $2.14 billion a
year[7].
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Stroke – The Symptoms
• Paralysis of One side of the body
• Vision Problems
• Speech Impairment
• Hearing Difficulties
• Impaired Neurological Activity
• Swallowing Difficulties
• Incontinence
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What is a Stroke?
• “An acute neurologic dysfunction of vascular
origin with sudden (within seconds) or at
least rapid (within hours) occurrence of
symptoms and signs corresponding to the
involvement of focal areas in the brain.” [8]
• “Strokes are caused by disruption of the
blood supply to the brain. This may result
from either blockage (ischemic stroke) or
rupture of a blood vessel (hemorrhagic
stroke).”[1]
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Stroke – The Causes
• Stroke risk factors include:
–Rapid Ageing
–Diabetes
–Obesity
–Smoking
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Stroke – Care Plans
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Rehabilitation – The Staff
– Nurses
– Physiotherapists
– Occupational Therapists
– Speech and Language
Therapists
– Dieticians
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[9]
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Musculoskeletal Therapy
Physiotherapists:
– Aerobic Fitness Training
– Arm Re-Education
– Positioning
– Strength Training
Occupational Therapists:
– Spatial Awareness
– Memory
– Social Interaction
– Driving
– Personal Activities Associated
with Daily Living.
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[9]
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Rehabilitation
• How Long, is Long Term Care?
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Costs
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Diagnosis costs
Inpatient care costs
Outpatient costs
Outpatient drug costs
Community care costs (including nursing homes)
Total Annual Direct Care Costs
(£ million)
60
530
46
507
1,700
2,800
Informal Care Costs
2,400
Income lost due to mortality
Income lost due to morbidity
Benefit payments
Total Annual Indirect Costs
480
600
690
1,800
Total Annual Cost
7,000
WMG
[10]
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Time
Time Spent with Patients across 4 European Centers
Average Daily Therapy
U.K.
Belgium
Germany
Switzerland
Time Patient Spends Lying or Sitting
U.K.
Belgium
Germany
Switzerland
Time Spent in Direct Therapy
U.K. Physiotherapy
U.K. Occupational Therapy
Germany Physiotherapy
Germany Occupational Therapy
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1hr
2hrs
2hrs 20mins
2hrs 46mins
5hrs
3.5hrs
<3hrs
<3hrs
45.9%
32.9%
66.1%
63.3%
[11]
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Tele-Rehabilitation
“Conventional rehabilitation
services at a distance, using
telecommunication technology
as the service delivery
medium[12].”
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Telerehabilitation - Examples
[13]
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Virtual Reality
[14]
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Augmented Reality
[14]
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Motion Tracking
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Motion Tracking
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Haptic interfaces
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Haptics
• http://www.youtube.com/watch?v=
m29Bih3ysgk [16]
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Our Project
• For Telerehabilitation to work we must:
– Track Progress
– Report Progress
• Project aim:
Create a low cost assessment system for
telerehabilitation.
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Current Assessment Methods
• Ad-Hoc
• Use assessment scales (e.g
Barthel)
• When and Which scales are used is
decided by each individual therapist
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Continual Assessment
• Assessment data taken remotely must
be comparable with ‘in-hospital’ data to
track progress
• We must provide a system which:
– Provides in and out of hospital
assessment
– Does not replace the role of the current
therapist
– Still provides the therapist with a useful
tool
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The System
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System Design
• Microsoft Kinect™
• Accelerometer
• Outputs:
– Graphs
– ADL outputs
– Prediction Algorithm?
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Two Stage System
• In-Hospital:
– Sits in background during
rehabilitation.
• Post-Hospital:
– Patient Carries on rehab at home
– Adaptive system
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Inputs
• Inputs:
– ROM from:
• Elbow
• Shoulder
• Wrist
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Outputs
• Outputs:
– ADL tasks that the patient is capable
of performing
– Graphs detailing ROM:
• During current session
• Throughout Therapy
– ROM over time can be used to predict
recovery times.
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ADL Tasks
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Skeletal Tracking
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ROM Graph
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ROM Over Time
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Conclusions
• Telerehabilitation could help
numerous people worldwide if
successful
• Telerehabilitation is coming to a
stage where it could soon be
deployed within healthcare
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References
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1. Mackay J, Mensah G. The atlas of heart disease and stroke. Geneva: World Health Organization; 2004
2. Australian Institute of Health and Welfare 2006. Australia’s Health 2006.
3. AG Thrift (personal communication). Estimates obtained using NEMESIS data (assuming no change in
incidence), and Australian Bureau of Statistics estimates of a changing population.
5. AIHW: Senes, S 2006. How we manage stroke in Australia.
6. AIHW: Senes S 2006. How we manage stroke in Australia.
7. Cadilhac, D., H. Dewey et al. Investing in Stroke – What are the potential cost offsets from the strokesafe
program. National Stroke Research Institute – Technical Report (Unpublished) 2005.
8. World Health Organization Task Force 1989. Recommendations on stroke prevention, diagnosis, and therapy.
Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke, 20, 1407-1431.
9. INTERCOLLEGIATE STROKE WORKING PARTY 2008. National clinical guideline for stroke. Suffolk: The
Lavenham Press.
10. NATIONAL AUDIT OFFICE 2005. Reducing Brain Damage: Faster Access to Better Stroke Care. Value for
Money Report. In: OFFICE, N. A. (ed.). London.
11. DE WIT, L., PUTMAN, K., SCHUBACK, B., KOMAREK, A., ANGST, F., BAERT, I., BERMAN, P., BOGAERTS, K.,
BRINKMANN, N. & CONNELL, L. 2007. Motor and functional recovery after stroke: a comparison of 4 European
rehabilitation centers. Stroke, 38, 2101.
12. Russell T. Telerehabilitation: A Coming of Age. Australian Journal of Physiotherapy. 2009;55.
13. VERSCHURE, P., CAMEIRAO, M., LEGROUX, S., BERMUDEZ, S. 2010. Research in neurorehabilitation [online].
Available at: http://specs.upf.edu/?q=projects/7 [accessed: 11/01/10].
14. U.S. DEPARTMENT OF DEFENSE – MILITARY HEALTH SYSTEM. 2009. Virtual Tech Makes Recovery a Reality at
Walter Reed [online]. Available at: http://www.health.mil/Press/Release.aspx?ID=958 [accessed: 12/01/10].
15. SILVA, R., OLIVEIRA, J. & GIRALDI, G. 2003. Introduction to augmented reality. Citeseer.
16. CLAHRC project, 2010. Novint Falcon and XNA. [online] Youtube. Available from:
http://www.youtube.com/watch?v=m29Bih3ysgk [Accessed 24/11/11].
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Thank you for listening.
ANY QUESTIONS?
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