Rehabilitation Technology
Introduction
The term "rehabilitation technology" means the systematic application of technologies, engineering
methodologies, or scientific principles to meet the needs of and address the barriers confronted by
individuals with disabilities in areas which include education, rehabilitation, employment,
transportation, independent living, and recreation.
The term includes rehabilitation engineering, assistive technology devices, and assistive
technology services.
Key factors for recovery
Motor learning principles
Motor learning application
1. Need for sufficient & progressive dosing of therapy intensity
Doing more → higher chance of enhancement
2. Limited generalizability of task & context-specific learning by rehabilitation
Strong evidence for PT interventions favoring intensive, high-repetitive exercises in all phases
poststroke
BUT effects are mostly restricted to the actually trained functions and activities
,Quantity of rehab therapy
CIMT (Constraint-Induced Movement Therapy) = no technology
- Immobilization of non-paretic arm with a padded mitt for 90%
of waking hours
- Task-oriented training with high number of repetitions for 6h a
day
- Behavioral strategies to improve compliance and transfer of
activities to patient’s home environment
→ Significant effect, but much less on FM score (body function level)
Animal studies: favorable plasticity use through high rehab doses of 600-700 repetitions/day
<-> Quantity of rehab therapy often too low in humans (mean of 32 arm repetitions/session)
Due to
- Financial constraints
- Access to rehab therapy providers
- Poor patient compliance with assignments
- Limited dose during stroke rehabilitation
Feedback technology
- Step counters to give feedback about number of steps you do in therapy session
- When meeting criteria: effects in walking and motor functions
Mode of rehab delivery
Home-based telerehab VS in-clinic therapy
- Home-based to prolong period of therapy
- Home-based has same effect as in-clinic → so home-environment rehab also possible
- Number of arm movement repetitions averaged 1,031/day!
Robots & electromechanical devices: hype or hope?
- Favorable effect for robotics
- Depressing results of robotic therapies for rehab upper limb: no beneficial effect
,Quality of rehab therapy
• Much more difficult to define and measure
Are technologies sufficiently personalized at the moment?
- Do technologies sufficiently allow adaptive movement strategies to occur, if adequate, by
allowing compensations?
o Restitution or compensation
- Do technologies sufficiently allow ecologically relevant movement practice, thereby increasing
motivation and carry-over to daily life?
o Valid to develop skills in ADL
→ Sweet spot is difficult to find
Sandwich of different layers
- Various levels of expertise
Synergy between therapist and technology
- Enhance human-centered approach to rehab
- Therapist and technology work together
- We don’t want that technology replaces the therapist
, Course content
Future: substitute skills to improve them
- Functional Electrical Stimulation
- Brain Stimulation
Timeline of technologically-supported upper limb rehab (Feys)
Illustrative paper
Introduction
First developments in technology-supported rehab
The Gustav Zander’s institute in Stockholm (founded in late 19th century)
- Featured 27 of the physician’s custom-built machines
- Strength and mobility training machines
Introduction
The term "rehabilitation technology" means the systematic application of technologies, engineering
methodologies, or scientific principles to meet the needs of and address the barriers confronted by
individuals with disabilities in areas which include education, rehabilitation, employment,
transportation, independent living, and recreation.
The term includes rehabilitation engineering, assistive technology devices, and assistive
technology services.
Key factors for recovery
Motor learning principles
Motor learning application
1. Need for sufficient & progressive dosing of therapy intensity
Doing more → higher chance of enhancement
2. Limited generalizability of task & context-specific learning by rehabilitation
Strong evidence for PT interventions favoring intensive, high-repetitive exercises in all phases
poststroke
BUT effects are mostly restricted to the actually trained functions and activities
,Quantity of rehab therapy
CIMT (Constraint-Induced Movement Therapy) = no technology
- Immobilization of non-paretic arm with a padded mitt for 90%
of waking hours
- Task-oriented training with high number of repetitions for 6h a
day
- Behavioral strategies to improve compliance and transfer of
activities to patient’s home environment
→ Significant effect, but much less on FM score (body function level)
Animal studies: favorable plasticity use through high rehab doses of 600-700 repetitions/day
<-> Quantity of rehab therapy often too low in humans (mean of 32 arm repetitions/session)
Due to
- Financial constraints
- Access to rehab therapy providers
- Poor patient compliance with assignments
- Limited dose during stroke rehabilitation
Feedback technology
- Step counters to give feedback about number of steps you do in therapy session
- When meeting criteria: effects in walking and motor functions
Mode of rehab delivery
Home-based telerehab VS in-clinic therapy
- Home-based to prolong period of therapy
- Home-based has same effect as in-clinic → so home-environment rehab also possible
- Number of arm movement repetitions averaged 1,031/day!
Robots & electromechanical devices: hype or hope?
- Favorable effect for robotics
- Depressing results of robotic therapies for rehab upper limb: no beneficial effect
,Quality of rehab therapy
• Much more difficult to define and measure
Are technologies sufficiently personalized at the moment?
- Do technologies sufficiently allow adaptive movement strategies to occur, if adequate, by
allowing compensations?
o Restitution or compensation
- Do technologies sufficiently allow ecologically relevant movement practice, thereby increasing
motivation and carry-over to daily life?
o Valid to develop skills in ADL
→ Sweet spot is difficult to find
Sandwich of different layers
- Various levels of expertise
Synergy between therapist and technology
- Enhance human-centered approach to rehab
- Therapist and technology work together
- We don’t want that technology replaces the therapist
, Course content
Future: substitute skills to improve them
- Functional Electrical Stimulation
- Brain Stimulation
Timeline of technologically-supported upper limb rehab (Feys)
Illustrative paper
Introduction
First developments in technology-supported rehab
The Gustav Zander’s institute in Stockholm (founded in late 19th century)
- Featured 27 of the physician’s custom-built machines
- Strength and mobility training machines
