Title: “Using Smart Watch Sensing in At-Risk Populations (SARP) System in Rehabilitation”
Presenters: Ramin Ramezani, PhD; Arash Naeim, MD PhD; Pamela Roberts, PhD, OTR/L, SCFES, FAOTA, CPHQ, FNAP, FACRM
Recent advances in technology allow for the possibility of more dynamic assessment and monitoring of older individuals across a variety of key environments including skilled nursing and inpatient rehabilitation. Within the past several years, “intelligent” easy-to-use electronic devices have been brought to market that are able to collect and transmit various types of biodata—patient position, time in motion, and even responses to questionnaires delivered remotely. These devices can also be paired with in-facility ambient activity and location sensors to monitor patient movement and activity continuously and provide real-time feedback about changes in patient status. Accurate assessments of functional improvement play a significant role in rehabilitation success. This study uses a smart watch based remote sensor system to monitor physical activity in real-time.
Objective: To examine whether the SARP system correlates to physical therapy (PT) and occupational therapy (OT) evaluations at baseline and to investigate whether measurable variables derived from the SARP system are associated with clinical outcomes including discharge disposition.
Design: A prospective cohort study
Setting and Participants: Skilled nursing facility, 99 subjects
Methods: SARP monitored physical activities as Total-Active time and it calculated Energy from motion signals. This included physical activity (ACTIVE) which was summarized by total active minutes in a day, total daily energy expenditure (ENERGY), calculated from smart watch motion signals as a summary measurement, time spent in the subjects’ room and out of the room were summarized based on the Bluetooth beacon location, and time spent in the room was further classified as the time present in the room, bathroom, or toilet. Descriptive statistics were computed for demographic variables; Spearman correlations were used to determine the association between SARP metrics and conventional measurements. Univariate logistic regression was used to identify predictors of discharge dispositions. Area under receiver operating characteristic curves (AUC) was used to evaluate the ability of the predictors to discriminate discharge dispositions.
Results: Participants’ mean age was 80.6 (SD 9.2) years, 77.6% had more than 10 active diagnoses and 12.1% were readmitted to an acute care hospital. There were 8 pairs of significant correlations identified between SARP metrics and conventional measurements (all p<0.05). All the conventional metrics except "Hygiene" differed significantly between the three discharge dispositions (p<0.05). There was a significant difference of “ACTIVE”, “ENERGY” and “Time spent in the room” among three discharge dispositions. Novel metrics “ACTIVE” and “ENERGY” were predictors for hospital readmission. (AUC=0/75 and 0.71 respectively, p<0.05)
Conclusion: The baseline SARP summary metrics were significantly associated with conventional therapists’ evaluation. The novel SARP summary metrics “ACTIVE” and “ENERGY” could discern discharge disposition.
Title: “LiveWell RERC State of the Science Conference: The Future of mRehab for People with Disabilities”
Presenters: Mike Jones, PhD, FACRM; John Morris, PhD, FACRM
Session 2 of the LiveWell RERC State of the Science Conference. This is a panel discussion on the current state and future directions for the development, deployment and adoption of mRehab solutions for people of all ages and abilities. The Plenary Speaker will review the current and emerging opportunities for measuring human activity and physiology using commodity hardware and services – and issues and challenges of collecting meaningful data and translating those data to meaningful action on the part of patients and clinicians. Two will provide additional perspectives on opportunities and obstacles to adoption by patients, the role of rehabilitation clinicians and enhanced clinical informatics.
The growth in mobile health and mobile rehab technologies and programs in recent years have produced rising expectations among consumers/patients, clinicians and healthcare delivery organizations. Yet, the current state of development of mHealth/mRehab solutions reveals numerous critical challenges and questions which must be address in order to move forward effectively:
Title: Purposeful Use of Functional Electrical Stimulation to Optimize Functional Outcomes
Presenters: Wendy Warfield, MSHA, OTR/L , Deborah Backus, PT, PhD, FACRM
Upon completion of this session, the audience will be able to:
1. Review the evidence and rationale for use of functional electrical stimulation (FES) rehabilitation interventions for people with Multiple Sclerosis (MS), and spinal cord injury (SCI);
2. Discuss the evidence for neuromuscular plasticity in people with CNS disorders following the use of FES interventions;
3. Describe considerations for choosing the parameters for FES that will best facilitate a given aspect of function or performance.
• Background/rationale for use of FES in Neurologic Populations (Warfield) (15 mins)
• Application of motor control principles that can be used to improve purposeful application of FES to induce neuromuscular plasticity and facilitate function: A potential algorithm for decision making (Backus) (15 mins)
• FES Ergometry to Optimize Neuromuscular Function (Backus) (15 mins)
• FES for Task-specific Training (Warfield) (15 mins)
• Demo and Wrap Up (Warfield) (15 mins)
Functional electrical stimulation (FES) is a tool that has been used in a variety of ways to decrease impairment and improve function and quality of life in people with neurological conditions. However, the use of FES interventions, such as FES devices and FES-assisted exercise has long been a central component of activity-based therapies.4-6 By combining multiple channels of stimulation and coordinated movement, FES not only activates or assists muscle contraction for the required motion (cycling or stepping), but may also provide somatosensory input from the stimulation and the resultant movement. These are principles known to be instrumental for inducing neuroplasticity and functional improvements.7 FES interventions also challenge muscle function and hypertrophy. The success of these devices, however, is dependent on the therapist’s skills in patient selection, device match, and parameter optimization.
This instructional course will present the theoretical underpinnings supporting the use of FES interventions to decrease impairment and improve function in people with SCI and MS. Attendees will learn strategies for appropriate patient selection, matching the device to the patient’s goals, and altering stimulation and cycling/stepping parameters to optimize the desired outcomes, including special considerations for different populations across the lifespan. We will use current evidence to outline the decision making and criteria that should be considered in each step of FES-assisted exercise prescriptions. We will highlight the specific challenges associated with maximizing exercise parameters in persons with tetraplegia, multiple sclerosis, lower motor neuron presentations, and children with spinal cord injury (SCI). Course participants will use these guidelines to work through a series of case examples and leave with strategies to implement in their own practice.
Title: “Implementing Rehabilitation Technology in Clinical Practice: Challenges and Lessons Learned”
Presenters: Rachel Proffitt, Lynne Gauthier, William Janes, Lauren Sheehan
Technology development has progressed rapidly in the past five years. Many rehabilitation technologies are past the point of user testing and the development phase and have progressed to clinical trials and implementation studies. However, the question remains: “Will these rehabilitation technologies eventually be accepted by and regularly utilized by consumers?” Even “low” assistive technologies are abandoned by consumers (eg., bathtub benches) without deliberate efforts to foster uptake and use. For many newly developed rehabilitation technologies, researchers and developers have utilized a User-Centered Design approach during initial development and testing. This approach increases the likelihood that end users (rehabilitation consumers and providers) will adopt and use the device, game, or system. Feasibility and acceptability studies are also necessary steps in the process of commercialization and eventual implementation of rehabilitation technologies. If end users are not accepting of the technology or none of the systematic barriers (eg., insurance, clinic space) are addressed, products are generally doomed to fail. This session, through a combination of presentations, demonstrations, and a panel, will address many of these concepts and provide real-world examples of technologies in various phases of development and implementation.
Title: “Technology Solutions to Enhance Supportive Homes and Communities”
Presenters: Alex Mihailidis, Ph.D P.Eng, Frank Knoefel, MD, CCFP (CoE), FCFP, MPA, Physician, Steve Robinovitch, Ph.D., Mark Elias, Goldie Nejat, PhD, P.Eng.
This symposium will give the audience a glimpse into the future of aging when it comes to using technology to improve the lives of older adults and their caregivers.
In Canada, 85% of seniors would like to age in the homes and communities that they know.
However, only 33% would consider installing smart home technology. Aging in place is about being able to live independently in one’s own home and community through appropriate supports and services, including the design of physical spaces and the use of technology within the environment.
This symposium will outline smart home and supportive rehabilitation technologies being developed by AGE-WELL, Canada’s Technology and Aging Network. These technologies can help seniors to live independently and improve their quality of life, while also supporting caregivers and providing a cost-effective alternative to long-term care.
Identify 3 solutions to help older adults age well in a home or community environment
Understand the potential of technology to help older adults maintain their independence
Describe the mission and vision of AGE-WELL, Canada’s technology and aging network
Title: “Magnetic stimulation for Neuromodulation in spinal cord injury: Models and Clinical Trial Results”
Presenters: Sue Ann Sisto, PhD; Anirban Dutta, PhD; Hemangi Dixit, MS student
1. Computational modeling of transpinal electromagnetic stimulation.
2. Poster presentation: Computational modeling of transpinal magnetic stimulation for neurogenic bladder.
3. SCI data on neuromodulation of the spinal cord acutely and after locomotor training