1. Strategic
Vision
This
research will examine the appropriateness and effectiveness of systems to
support hospital or home-based rehabilitation programmes for older people who
have sustained a stroke, and their carers, the aim being the recovery and
improvement of mobility. The
system will employ video and ambulatory monitoring systems linked to a
decision support platform that will provide both therapeutic instruction and
support information. This
combination of technology and knowledge management will support specific
rehabilitation interventions and measure the effectiveness of the resulting
actions undertaken by the participant.
Information regarding process will be fed back to the person in an
appropriate format (audio/ visual) and where appropriate, their carers or
health care professionals. The
SMART monitoring technology we propose to develop will reduce the need for
“hands-on” therapy from a trained therapist, with expert support being
provided through video and audio feedback.
Scope
of the problem
Stroke is the biggest cause of severe disability in the UK. Ten thousand people each year experience a first stroke, and a further 3,000 have a further stroke (Stroke Association, 2001). The majority of people who sustain a stroke are elderly. They may have been previously well and managing independently but following the stroke can find themselves suddenly hospitalised or receiving hospital services at home, with subsequent needs for rehabilitation and lifestyle adjustments. The DoH Health of Older People survey (DoH, 2000) confirmed that 65% of people in residential or nursing home have a serious locomotor disability and 54% experience problems with personal care. Therefore the maintenance of mobility is a key factor in enabling people to remain at home. Falls are a direct consequence of stroke (Swift, 2001), with falls and fear of falling leading to dependence and isolation. Other research has found that the degree of disability is a more important indicator of needs for services than whether a disability is present or absent (MRC CFAS, 2000). Active treatment to improve mobility in older people can therefore help to maintain independence, reduce the likelihood of falls (and their consequences) and limit admission to long term care. There is strong evidence that organised stroke care improves outcomes (Cochrane Library Issue 2 2002) and the National Clinical Guidelines on Stroke recommended that rehabilitation should commence as soon as possible after the stroke (Intercollegiate Working Party, 1999), although active rehabilitation and advice is beneficial at all stages of the care pathway (Forster and Young, 2002). The National Service Framework for Older People recommends that rehabilitation should continue until maximum recovery has been achieved (DoH, 2001).
Telemedicine is an area of considerable current interest and promise.
A number of applications have already been developed to support various
aspects of health and social care delivery (South and East Belfast Trust,
undated, Hanson and Clarke, 2000). Where technology has been developed to
assist in independent tasks of daily living there is evidence that elderly
people have generally very positive attitudes to their use (Mann, Hurren &
Tomita, 1995). However, as yet there has been little consideration of the
possible use of this technology to support rehabilitation and there is nothing
known of whether and how elderly patients will use technology to assist or
replace face to face therapy. We
believe that it will be possible to devise effective technologies to support
the active rehabilitation of older people with stroke in their own homes.
Moreover, we seek to ensure that the resulting technology is
acceptable, easily used and able to meet the needs of professionals, service
users and carers.
3.
Theoretical Framework
In
this project we will develop two smart monitoring systems, chosen to represent
a high and low level of complexity, to capture kinematic data from individual
physiotherapy interventions. Both will use wireless technology to link to a
data processing module and a common decision support platform and will be
capable of being temporarily installed in homes for a 2-3 month period.
Automated motion capture system (AMCS): There are now a number of commercial 3D optical tracking systems which provide real time positional information using as many as 60 markers placed on key anatomical points. The systems provide full kinetic and kinematic modelling for gait and movement analysis in a laboratory setting. The systems are expensive; the data are complex, require a high level of technical expertise to interpret and are not suitable for a general clinical rehabilitation environment. We will examine whether this technology can be scaled down to provide useful information to support rehabilitation using a limited number of markers on a range of simple sit-stand-sit, or lower limb exercises. This is a complex intervention and we will limit the scope to data items that are common to the main treatment approaches used in the UK (Forster 2002).
Motion tracking system (MTS): Activity monitors based on miniature accelerometers have been commercially available for clinical research applications for at least 5 years. They record changes in position and acceleration and store the data in solid state memory for off line analysis (Veltnik 1996). The type (number of axes), number of accelerometers and their placement determines the type of information that is available. The Dynaport system (McRoberts NL) uses 3 accelerometers and is able to classify and then quantify basic movement patterns such as walking, lying down and climbing. These devices can provide information on the outcome of therapeutic or rehabilitation interventions but have not been used to provide real time data for therapy in a home environment. We propose to develop a real time tracking system utilizing a customised 3-axis accelerometer that can be incorporated within a bean bag or similar type of training aid.
More background information:
Ambulatory monitoring of physical activity in working situations, a validation study
Detection of static and dynamic activities using uniaxial accelerometers
4.
Project Aims
All partners will be involved in the drawing up of a comprehensive dissemination plan. In cooperation with the Stroke Association we will identify appropriate workshops and seminars where the material can be presented in both verbal and written formats for a variety of audiences. It will also be our intention to publish significant findings in appropriate professional and technical journals, and present at up to three conferences of international standing.