ORIGINAL ARTICLE   Free access

European Journal of Physical and Rehabilitation Medicine 2018 August;54(4):545-53

DOI: 10.23736/S1973-9087.17.04802-X

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Autonomous rehabilitation at stroke patients home for balance and gait: safety, usability and compliance of a virtual reality system

Jeremia P. HELD ^{1, 2} ✉, Begoña FERRER ³, Renato MAINETTI ⁴, Alexander STEBLIN ⁵, Benjamin HERTLER ¹, Alberto MORENO-CONDE ⁶, Alvaro DUEÑAS ⁶, Marta PAJARO ⁶, Carlos L. PARRA-CALDERÓN ⁶, Eloisa VARGIU ⁵, Maria JOSÈ ZARCO ⁶, Maria BARRERA ⁶, Carmen ECHEVARRIA ⁶, Francisco JÓDAR-SÁNCHEZ ⁶, Andreas R. LUFT ^{1, 2}, N. Alberto BORGHESE ⁴

¹ Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich, Zurich, Switzerland; ² Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland; ³ Andalusian Health Service, Department of Physical Medicine and Rehabilitation, Virgen del Rocío-University Hospital, Seville, Spain; ⁴ Applied Intelligent Systems Laboratory, Department of Computer Science, University of Milan, Milan, Italy; ⁵ Health Unit, Eurecat Technology Center, Barcelona, Spain; ⁶ Group of Research and Innovation in Biomedical Informatics, Biomedical Engineering and Health Economy, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital, University of Seville, Seville, Spain

BACKGROUND: New technologies, such as telerehabilitation and gaming devices offer the possibility for patients to train at home. This opens the challenge of safety for the patient as he/she is called to exercise neither with a therapist on the patients’ side nor with a therapist linked remotely to supervise the sessions.
AIM: To study the safety, usability and patient acceptance of an autonomous telerehabilitation system for balance and gait (the REWIRE platform) in the patients home.
DESIGN: Cohort study.
SETTING: Community, in the stroke patients’ home.
POPULATION: Fifteen participants with first-ever stroke, with a mild to moderate residual deficit of the lower extremities.
METHODS: Autonomous rehabilitation based on virtual rehabilitation was provided at the participants’ home for twelve weeks. The primary outcome was compliance (the ratio between days of actual and scheduled training), analyzed with the two-tailed Wilcoxon Mann-Whitney test. Furthermore safety is defined by adverse events. The secondary endpoint was the acceptance of the system measured with the Technology Acceptance Model (TAM). Additionally, the cumulative duration of weekly training was analyzed.
RESULTS: During the study there were no adverse events related to the therapy. Patients performed on average 71% (range 39 to 92%) of the scheduled sessions. The TAM Questionnaire showed excellent values for stroke patients after the training. The average training duration per week was 99±53min.
CONCLUSIONS: Autonomous telerehabilitation for balance and gait training with the REWIRE-system is safe, feasible and can help to intensive rehabilitative therapy at home.
CLINICAL REHABILITATION IMPACT: Telerehabilitation enables safe training in home environment and supports of the standard rehabilitation therapy.

KEY WORDS: Stroke - Rehabilitation - Virtual reality - Telerehabilitation - Gait