This only talks about providing occupational therapy not delivering recovery that OT should be doing. So useless.
Application of intelligent rehabilitation equipment in occupational therapy for enhancing upper limb function of patients in the whole phase of stroke
Keywords
1. Introduction
Stroke is a general term for a class of brain injury diseases caused by blockage or rupture of blood vessels[1]. It is one of the leading causes of death in the Chinese population in 2017[2]. 80% of stroke survivors may be disabled for a period of time[3]. The difficulties of stroke include physical, cognitive, communication, sensory and perceptual problems, etc[4]. All of these conditions affect patients’ return to their original lives and works, bringing huge burdens to their families[5]. Among these problems, the most significant one is physical dysfunction, particularly the upper limb dysfunction[6]. Almost half of the stroke survivors experienced different degrees of chronic impairment of upper limb function[7], which seriously decrease patients’ participation in self-care activities, reduce their working output, affect social reintegration, and finally lead to economic and social burdens[8]. The other important aspect is that the sudden onset of illness may cause an increased risk of psychological problems[9]. In the early weeks following the stroke, about 30% of the patients reported depression, and 20% reported anxiety[10]. These emotional conditions decline patients’ motivation to participate in rehabilitation training and eventually affect the recovery of their physical function. This vicious circle formed by physical dysfunction and psychological problems weakens patients’ function, reduces the independence of daily activities, slows down their pace of returning to the original life, and aggravates the human and financial costs on the family and society. To help patients with stroke regain the ability in activities of daily livings(ADLs), occupational therapy(OT) is being applied through various interventions to promote the physical function and mental state of patients.
As a health care profession, OT focuses on helping patients achieve their goals in their daily lives[11]. The methods we use in OT are not only the extension of functional training but also a process to help patients acquire new abilities to achieve their lives. As a result, OT can be regarded as a bridge connecting the patient with his or her family and society.
When treating stroke patients, occupational therapists are concerned with the patients’ acquisition and maintenance of skills necessary to perform daily tasks, such as dressing, feeding, mobility, grooming, and communication[12]. It is a particular challenge for occupational therapists to integrate various problems faced by stroke patients and draw up treatment plans. Because of the irreplaceable role of upper limb function in the implementation of activities of daily living (ADLs)，the dysfunction of the upper limb makes the patients have less access to their ADLs[13]. Thus, the primary issue that needs to be concerned when the OT is treating the patient with stroke is that how to remedy or compensate the function of the affected limb to the most extent, to improve the independence of patients' activities of daily living. OT intervention can run through the whole process of stroke patients from onset to return to their families[14].
Nevertheless, in the clinical practice of OT for patients with stroke, there are many problems need be solved in the conventional OT intervention(1) (Fig. 1). First of all, it is the inefficient use of human resources. Occupational therapists in hospitals and rehabilitation institutions usually provide OT service to patients in the form of one-to-one, and the treatment time ranges from 20 minutes to 1 hour[15]. This form reduces the efficiency of the OT interventions. In the meanwhile, it increases the medical cost of the hospital and society. Secondly, the intensity of the patient's training did not reach the expectation[16]. The time for a stroke patient to participate in the upper limb exercise is not enough in a treatment session, and the patient does not have continuous services to achieve the purpose of promoting motor learning[17]. Also, the conventional OT can not take the multiple sensory inputs into account during the treatment, which may promote the connection between the sensory cortex and motor cortex, so as to improve the motor function of the patient. From the perspective of mechanism, the effect of conventional OT is generalized, which may not catalyze the reorganization of cortical function specifically. So, the therapeutic effect can not be expected[18]. Last but not least, the continuing service of OT resources is incomplete. In the inpatient settings, most of the patients have access to health services from the rehabilitation team, such as occupational therapy, physical therapy and speech therapy. However, as the patients’ discharge from the hospital, only about a third of the patients received rehabilitation care in the first 30 days following discharge home[19]. There is still a significant gap in continuous rehabilitation services support.
Fig. 1. Problems that need to be solved in the conventional occupational therapy
Currently, the application of intelligent technologies has become the mainstream trend in all walks of life. (2)Intelligent rehabilitation device combines assistive technology and artificial intelligence to promote the development of physical, cognitive and psychological rehabilitation in terms of informatization, standardization, and intelligence[20]. It is a kind of high-tech equipment with the ability of perception, which can capture and record the strength, accuracy, and speed of the patient’s movement in real time[21]. After analyzing the recorded data, the intelligent rehabilitation device can give the corresponding feedback to adjust the training program and difficulties[22] [23]. The executive function of intelligent rehabilitation equipment is to provide appropriate guidance and correction when patients make wrong decisions[24]. When patients are in danger, intelligent rehabilitation equipment also can respond in time to protect the patients. It can be combined with occupational therapy to provide services for patients no matter the period (acute phase, sub-acute phase, recovery phase), different settings (hospital, nursing center, home), or for multiple purposes (evaluation, training, application in daily life). The purpose of using the equipment is to make up for the deficiency of conventional occupational therapy, as well as to enhance the effect of occupational therapy for patients with stroke. For example, transcranial magnetic stimulation (TMS) can activate the motor cortex according to the patient's condition combining with upper limb function training to improve the motor function of the upper limb for better participation in ADLs[25,26]. The upper limb robot assist patients with upper limb function training, improve the frequency of patients using the affected limb, and promote the desired movement[27]. Virtual Reality (VR) technology provides virtual interaction and feedback through visual, auditory, and other aspects of sensory input while increasing the interest of patients to complete controllable body movement[28]. It can stimulate and maintain the patients’ motivation to practice repeatedly, regulate their emotions, and improve their depression and anxiety[29]. Brain-Computer Interfaces (BCI) use the neural activity of the stroke patients to directly control external hand devices with real-time feedback[30].
Therefore, the application of intelligent rehabilitation equipment in occupational therapy has many advantages. It supports therapists in their abilities through providing high-intensive, repetitive, and task-oriented treatment to enhance the recovery process and obtain better occupational performance. The combination of occupational therapy and intelligent rehabilitation equipment may strengthen the therapeutic effects of each other to achieve desired outcome and participation in daily activities. Intelligent rehabilitation devices are changing the mode of occupational therapy in the whole phases of stroke (Fig. 2).
Fig. 2. The process of OT evaluation and intervention for patients with stroke through the whole phase of the disease.
No comments:
Post a Comment