Search

Respiratory rehabilitation is a therapeutic path based on performing regular physical exercise. It aims to modify the impact that the respiratory disease has on the patients' quality of life, reducing the severity of the symptoms, and improving their ability to adhere to the activities of daily life. After an initial assessment, they are prescribed (1) different forms and modes of physical exercise and (2) exercise of pulmonary musculature to improve individual performance and the consequences of the symptoms of the emotional sphere related to the pathological condition. At the moment, the devices for pulmonary exercitation/incentivization, even if gamified, give out qualitative information and are not provided with electronics and/or are not connected to the network. The objective of this opinion article is to introduce new models of rehabilitation in this field of Telemedicine and e-Health at a first stage of research. In particular, a new environment for home rehabilitation is proposed, which is based to gamified devices for pulmonary incentivization integrated to the e-Healthcare system integratable also with automatic systems for the 6-min walk tests proposed by the same authors. A first device has been designed and tested. The next steps will be dedicated to the widening of the environment with the design of other devices and to complete the integration with the healthcare system.

When designing a complete system of daily-telerehabilitation it should be borne in mind that properly designed methodologies should be furnished for patients to execute specific motion tasks and for care givers to assess the relevant parameters. Whether in hospital or at home, the system should feature two basic elements: (a) instrumented and walking aids or supports, (b) equipment for the assessment of parameters. Being gait the focus, the idea was to design, construct and validate - as an alternative to the complex and expensive instruments currently used - a simple, portable kit that may be easily interfaced/integrated with the most common mechanical tools used in motion rehabilitation (instrumented walkways, aids, supports), with feedback to both patient for self-monitoring and trainer/therapist (present or remote) for clinical reporting. The proposed system consists of: one step-counter, three couples of photo-emitter detectors, one central unit for collecting and processing the telemetrically transmitted data; a software interface on a dedicated PC and a network adapter. The system has been successfully validated in a clinical application on two groups of 16 subjects at the 1st and 2nd level of the Tinetti test. The degree of acceptance by subjects and care-givers was high. The system was also successfully compared with an Inertial Measurement Unit, a de facto standard. The portable kit can be used with different rehabilitation tools and different ground rugosity. The advantages are: (a) very low costs when compared with optoelectronic solutions and other portable solutions; (b) very high accuracy, also for subjects with imbalance problems; (c) good compatibility with any rehabilitative tool., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background: When designing a complete process of daily telerehabilitation, it should be borne in mind that patients should be furnished with properly designed methodologies for executing specific motion tasks and the assessment of the relevant parameters. In general, such a process should comprehend three basic elements in both the hospital and the home: (a) instrumented walkways, (b) walking aids or supports, and (c) equipment for the assessment of parameters. The objective, with gait being the focus, of this study was thus to design a simple, portable kit-as an alternative to the complex and expensive instruments currently used-to be easily interfaced or integrated with the instrumented walkways and aids/supports both for self-monitoring while patients are exercising with their own aids and for clinical reporting., Materials and Methods: The proposed system is a portable kit that furnishes useful parameters with feedback to both the patient and the trainer/therapist. Capable of being integrated with the most common mechanical tools used in motion rehabilitation (handrail, scales, walkways, etc.), it constantly monitors and quantitatively assesses progress in rehabilitation care. It is composed of one step counter, photo-emitter detectors, one central unit for collecting and processing the telemetrically transmitted data, and a software interface., Results and Discussion: The system has been successfully validated on 16 subjects at the second level of the Tinetti test in a clinical application for both home and the hospital. The portable kit can be used with different rehabilitation tools and on varying ground rugosity. Advantages include (a) very low cost, when compared with optoelectronic solutions or other portable devices, (b) very high accuracy, also for subjects with imbalance problems, compared with other commercial solutions, and (c) integration (compatibility) with any rehabilitative tool.

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.

Thermal imaging of the skin has been used for several decades for monitoring of temperature distribution of human skin for the detection of thermal abnormalities indicating pathologies (malignancies, inflammation, infection, and vascular, dermatological, and rheumatic disorders). Literature has shown that to detect and monitor the thermal abnormalities related to pathologic conditions, there is a need to extend acquisition over 8, 12, 16, or 24 hours. A wearable device is strongly needed in contact thermography to reach the objective of long-term monitoring of contact thermography, especially in telemedicine applications. A wearable system has been designed and constructed that allows the continuous thermographic monitoring of a skin region at the point of affixation. Measurement allowed by this system is direct and not hampered by the influence of the environment--as with IR thermography--nor by the geometry of skin surface (curvatures, roughness) thanks to the flexible adaptation of the sensing head to the surface. The validation of the system embedded in a pilot preliminary telemedicine application was successful. The next step will be the wide focusing and adaptation to telemedicine clinical applications to assess the response to the chemotherapy and tune the therapy at home of the breast cancer or the response to the inflammation care.

Due to major advances in the information technology, telemedicine applications are ready for a widespread use. Nonetheless, to allow their diffusion in National Health Care Systems (NHCSs) specific methodologies of health technology assessment (HTA) should be used to assess the standardization, the overall quality, the interoperability, the addressing to legal, economic and cost benefit aspects. One of the limits to the diffusion of the digital tele-echocardiography (T-E) applications in the NHCS lacking of a specific methodology for the HTA. In the present study, a solution offering a structured HTA of T-E products was designed. The methodology assured also the definition of standardized quality levels for the application. The first level represents the minimum level of acceptance; the other levels are accessory levels useful for a more accurate assessment of the product. The methodology showed to be useful to rationalize the process of standardization and has received a high degree of acceptance by the subjects involved in the study.

In the management of stroke, after the first critical care period at the hospital, it is important for the subjects to plan a neural and motion rehabilitation program at home. Telerehabilitation could represent a valid aid for subjects involved in a rehabilitation process at home. Motion and neural rehabilitation are strictly correlated. Prompt motion rehabilitation is essential to ensure good recovery performance from the stroke defect. Remote therapy, which involves a telerehabilitation program, should monitor daily motion activity. An optimal telerehabilitation program should be capable of monitoring patient activity starting from a high disability of imbalance, when there is the need for properly designed aids or prosthesis. The program should continue when the patient improves his or her condition, and progressively changes or abandons aids or prosthesis. New home care for remote activity monitoring has been proposed. It includes a sensorized-codivilla-spring and a gastrocnemius expansion measurement unit to allow activity monitoring in terms of step-counting for the continuity of care at home. This home care has been integrated in a telerehabilitation process. Preliminary clinical trials have shown the effectiveness and the high degree of client satisfaction (patient and therapist). The next phase will be the integration with other units to allow the monitoring of other physiological parameters (blood pressure, heart rate, blood glucose) useful to investigate in stroke telerehabilitation.

We have designed and constructed force measurement equipment to assess hand-finger function in pressing tasks. The equipment was used for monitoring the follow-up of five hand-transplanted subjects. Interactive software was integrated into the instrument to monitor the functionality of the hand and fingers during exercises in realtime. The interactive software included biofeedback to provide realtime quantitative responses for the patient and the therapist. Acceptance of the system was investigated with patients and therapists: the system was found to be user-friendly and effective; it was practical both for patients and therapists. The system could be used in a telerehabilitation centre or in a patient's home.

Hand rehabilitation requires continuous and frequent monitoring of the functionality in order to assess therapy and/or refine it. In order to contain costs for the rehabilitation program, a telehomecare rehabilitation system is suitable. The purpose of this paper was to describe the setup and configuration of a homecare device for telemonitoring/telerehabilitation of patients who underwent hand transplant. The telehomecare device allows the assessment of dynamics and kinematics of hand function by integrating dedicated software in two components. The first was a commercial glove, the HumanGlove by Humanware (Pisa, Italy). The second was a set of instruments for the measurement of digit force using an Instrumented Keyboard and an Instrumented Mouse-Like device. The software integrating the devices is composed of two modular components. The first is to drive the devices; the second is for the data-analysis and display. The methodology was validated at the Istituto Superiore di Sanit (the Italian National Institute of Health) in the framework of an Italian National Project, funded by the Ministry of Health.

Step counting is an important index of motion in telemonitoring. One of the most diffused wearable systems, designed for this purpose, is the pedometer. The accuracy of commercial pedometers has been reported in the literature. Several limits have been found in many commercial systems both in healthy subjects and in people with disabilities. Furthermore, commercial pedometers lack interoperability. This paper introduces a new wearable system for step counting for telemonitoring applications. This system is based on a wearable device with a force-sensing resistor. It is affixed on the gastrocnemius muscle for monitoring muscular expansion correlated with the gait. The data exchange is assured by the XTR-434H (Aurel, FC, Italy) telemetric system. The proposed gastrocnemius expansion measurement unit (GEMU) was tested on 5 subjects with Parkinsons disease at Level 3 of the Tinetti test of unbalance. Ten repetitions of 500 steps with three different speeds (fast, slow, and normal) were performed. The mean error was <0.5%. Results also showed that GEMU performed better than an accelerometer unit (considered in the literature the best solution for this disability). The study showed that GEMU had a high performance in subjects with Parkinsons disease, causing a high degree of unbalance that confounded motion style. The next phase will be the optimization of GEMU for long-term medical applications at the patients home.

The hand rehabilitation process needs a continuous and frequent monitoring of the patient's functionality in order to test the delivered therapy and/or adapt it to the patient's progress. In order to contain costs for the rehabilitation program, a tele-homecare rehabilitation system is suitable. We have proposed a tele-home-care allowing the assessment of the hand fingers' dynamics and kinematics by integrating with a dedicated software two particular devices: the first was a commercial glove, the HumanGlove by Humanware (Pisa, Italy) and the second was a set of instruments for the measurement of the hand fingers' force comprehending an Instrumented Keyboard (IK) and an Instrumented Mouse-Like (IML) device. The platform has been successfully tested at Istituto Superiore di Sanità (ISS).