http://journals.sagepub.com/doi/abs/10.1177/1545968316680490
Bruce H. Dobkin, MD
Abstract
Although
motor learning theory has led to evidence-based practices, few trials
have revealed the superiority of one theory-based therapy over another
after stroke. Nor have improvements in skills been as clinically robust
as one might hope. We review some possible explanations, then potential
technology-enabled solutions. Over the Internet, the type, quantity, and
quality of practice and exercise in the home and community can be
monitored remotely and feedback provided to optimize training frequency,
intensity, and progression at home. A theory-driven foundation of
synergistic interventions for walking, reaching and grasping,
strengthening, and fitness could be provided by a bundle of home-based
Rehabilitation Internet-of-Things (RIoT) devices. A RIoT might include
wearable, activity-recognition sensors and instrumented rehabilitation
devices with radio transmission to a smartphone or tablet to
continuously measure repetitions, speed, accuracy, forces, and temporal
spatial features of movement. Using telerehabilitation resources, a
therapist would interpret the data and provide behavioral training for
self-management via goal setting and instruction to increase compliance
and long-term carryover. On top of this user-friendly, safe, and
conceptually sound foundation to support more opportunity for practice,
experimental interventions could be tested or additions and replacements
made, perhaps drawing from virtual reality and gaming programs or
robots. RIoT devices continuously measure the actual amount of quality
practice; improvements and plateaus over time in strength, fitness, and
skills; and activity and participation in home and community settings.
Investigators may gain more control over some of the confounders of
their trials and patients will have access to inexpensive therapies.
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