Finally on Saturday, we had Jane Burridge present Tele-health in Stroke Recovery: Intensity and Independence.
Therapy is expensive. We all know that. Because of that, 3rd party payors are pushing for more efficient therapy. What they are willing to pay for now doesn’t even meet the minimal intensity requirements to truly make neuroplastic changes. So the model of therapy we need to adopt to get people to the places they want to be functionally after a stroke is going to involve we therapists changing our own mindsets. We need to be prepared to put more responsibility in the hands of the patients and their caregivers, so they can rehab themselves at home.
Most of the research is telling us that the more kinematically correct repetitions you get of a movement, the more neuroplastic and therefore functional change you will get. In animal studies, they’re needing 400-600 reps to show functional neuroplastic changes. In an average therapy session, the human patients are getting about 32 reps. And that’s when their actually in therapy. In the typical inpatient setting, the patient is sitting there in their rooms totally alone 60% of the time doing nothing. That doesn’t seem very efficient or effective to me.
So what’s a therapist/patient team to do? Jane is recommending the use of body worn sensors to monitor intensity for therapist, but to also decrease the dependence of the patient on the human therapist to provide feedback about how to perform the activities. Jane is using sensors that monitor surface EMG that are imbedded in clothes called the M-MARK to provide this information. The “shirt” for lack of better terms, is washable; you just have to pop the sensors off. It looks like it fits like a Dri-Fit type of shirt. It is connected to a software program for the therapists to monitor intensity and make suggestions for exercises. Then the patient also gets feedback on the quality of movement he/she makes, with the possibility to game-ify the interface. This way the patient can do their own therapy at home. This is still in the infant stage of research. They’re hoping to do a feasibility study with 10 patients in their own homes soon.
Jane also mentioned that they are looking into this idea with constraint-induced movement therapy (CIMT) as well in the UK. They have developed an online platform to guide patients to do CIMT in their own homes. CIMT is very effective in improving arm function after a stroke. What you do is you take the good hand and tie it up in a mitt, so you’re forced to use the effected arm more. Which is all well and good, but for it to really work, you have to do this kind of therapy SEVEN HOURS a day. Which no one is going to pay for in a clinically setting, so LifeCIT (the online platform) is perfect for this kind of treatment! So LifeCIT first educates the user on what CIMT is, then asks a series of questions to determine the patient’s current functional level with the effected arm. Then it takes that information and creates an exercise and daily activity (brushing hair, set table, do a puzzle, etc.) program for the patient to do. It will also help the user to set their own goals for using CIMT treatment in their daily lives and also to play games on the platform. Then at the end of teach treatment day, the patient enters in their progress for the day and graphically shows them their own progress toward their goals. It also gives tips on what to do if they aren’t meeting their goals. The benefits of LifeCIT the first trial patients reported were that they liked being able to chose their own goals, the tips on what to do if they got frustrated, seeing a functional improvement and getting more family time as younger members of their families tended to get involved to help navigate the computer. LifeCIT is still being investigated, but you can click the link to see the landing page for LifeCIT anyway. You have to be enrolled in their research to actually access it. I hope it works out, because it looks great to me!
I think these technologies are perfect to pair with telehealth to increase reps, neuroplastic changes and functional progress. They are a good answer to these comments from patients: “Recovering from stroke is like watching paint dry– it’s difficult to keep motivated when you don’t seem to be improving,” and “I want to practice at home, but I’ve no idea whether what I am doing is right.”
That concludes Saturday’s lecture sessions. Whew! That’s a lot to think about!