19 pages for your doctor to use to update your stroke protocols.
Abstract
In this paper we present the results of a two-year study aimed at developing a full-fledged computer environment supporting post-stroke rehabilitation. The system was designed by a team of computer scientists, psychologists and physiotherapists. It adopts a holistic approach to rehabilitation. In order to extend the rehabilitation process, the applied methods include a remote rehabilitation stage which can be carried out of at the patient’s home. The paper presents a distributed system architecture as well as results achieved by patients prior to and following a three-month therapy based on the presented system.
Introduction
Stroke continues to be a major public health concern, with more than 790000 new cases per year in the USA [20]. In Italy (180000 cases/year, 80% first episodes, 20% recurrent) it is the 3rd leading cause of death (following cardiovascular disease
and cancer) and the leading neurological cause of disability. Throughout the 27 EU countries the total annual cost of stroke is estimated at 27 billion (68.5% direct and 31.5% indirect costs) [6].
Brain tissue damage caused by stroke is organic in character and usually results in impairment of basic brain functions controlling important biological processes. Common disabilities that result from a stroke include: decreased attention span, selective
attention deficit, decline in logical thinking, difficulty in performing planning and reasoning tasks, poor comprehension, synthesis and analysis skills, weakened short-term
and long-term memory (verbal and/or visual) as well as speech disorders (e.g. aphasia or dysarthria). This leads to accumulation of symptoms which require therapeutic care. Post-stroke patients are often unable to fulfill their social or professional obligations. Difficulties in adapting to everyday life frequently produce mood disorders such as anxiety, irritability and apathy. Lack of self-reliance and reduced intellectual abilities often prevent patients from achieving their life goals and contribute to depression. Due to its complexity, this type of medical condition calls for a holistic and
individualized approach to each patient. Rehabilitation plays a vital role as it helps stroke victims recover their mental faculties – partly or fully – following brain injury. The choice of exercise plays a vital role, as does its correct and systematic performance. In addition, the duration of rehabilitation is very important. Modern information technologies enable remote, individualized outpatient rehabilitation, with proper supervision by physiotherapists or medical doctors. [4, 10, 17, 18, 21]
In this paper we present the results of a two-year project aimed at developing a full-fledged computing environment supporting post-stroke rehabilitation carried out at a rehabilitation centre and then continuing at the patient’s home. The goal of the project was to validate the following hypotheses:
• Use of resources and tools provided by computer science enables the adoption of a holistic approach to rehabilitation of stroke patients, based on computerized support for concurrent stimulation of cognitive functions, motor skills and verbal faculties.
• Holistic approach to the rehabilitation of stroke patients yields better results than traditional methods which do not exploit IT tools. It is also better than computerized methods which do not adopt a holistic approach.
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