This markerless motion capture technology could capture objective damage diagnosis of movements, but then there are NO EXACT STROKE REHAB PROTOCOLS available that will deliver recovery!
Exploring stroke survivors’ and physiotherapists’ perspectives of the potential for markerless motion capture technology in community rehabilitation
Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 168 (2024)
Abstract
Introduction
Many stroke survivors do not receive optimal levels of personalised therapy to support their recovery.(Well, yeah! Because your competent? doctor and hospital haven't initiated the research that will get survivors to 100% recovery! Blame the correct persons! Your stroke medical 'professionals'. They really aren't professionals if they aren't even trying to solve stroke, are they?) Use of technology for stroke rehabilitation has increased in recent years to help minimise gaps in service provision. Markerless motion capture technology is currently being used for musculoskeletal and occupational health screening and could offer a means to provide personalised guidance to stroke survivors struggling to access rehabilitation.
Aims
This study considered context, stakeholders, and key uncertainties surrounding the use of markerless motion capture technology in community stroke rehabilitation from the perspectives of stroke survivors and physiotherapists with a view to adapting an existing intervention in a new context.
Methods
Three focus groups were conducted with eight stroke survivors and five therapists. Data were analysed using reflexive thematic analysis.
Results
Five themes were identified: limited access to community care; personal motivation; pandemic changed rehabilitation practice; perceptions of technology; and role of markerless technology for providing feedback.
Conclusions
Participants identified problems associated with the access of community stroke rehabilitation, exacerbated by Covid-19 restrictions. Participants were positive about the potential for the use of markerless motion capture technology to support personalised, effective stroke rehabilitation in the future, providing it is developed to meet stroke survivor specific needs.
Introduction
Stroke is a leading cause of long-term disability, often resulting in a combination of sensory-motor, communication, visual, and cognitive impairments [1]. While some survivors recover, many remain with considerable levels of disability after stroke [1]. These disabilities can affect stroke survivors’ quality of life and limit their ability to reintegrate into society or return to employment.
In the UK, guidelines recommend admission to a hyperacute stroke ward as soon as possible. There, depending on the mechanism, people affected by stroke will receive the necessary imaging, monitoring and thrombolytic or antithrombotic management [2]. Early mobilisation, forming the initial basis of stroke survivors physical therapy rehabilitation journey, is recommended within 24 h of the onset of the stroke [2]. Whilst guidelines recommend that access to rehabilitation services should be determined by stroke specific goals, access and onward referral to further inpatient rehabilitation, specialist stroke therapy rehabilitation centres and early supported discharge services vary according to availability, length of stay, or number of sessions provided.
Rehabilitation aims to minimise activity limitations and participation restrictions and may draw on repetitive, task-specific practice with appropriate equipment and feedback in a functionally relevant context. Appropriate levels of rehabilitation, which integrate these principles, can lead to improved movement and outcomes [3,4,5], while restricted rehabilitation access is associated with poor recovery profiles and readmissions [4]. Recently updated guidelines recognise the link between increased access to rehabilitation and improved recovery [2]. The recommended dosage in the new guidelines has increased from 45 min a day, seven days a week, to 3 h of multidisciplinary therapy a day at least 5 days a week [2]. However, it is acknowledged that previously recommended volume of therapy was commonly inaccessible for patients [6,7,8] and stroke survivors can experience difficulties in adequately accessing rehabilitation services following discharge [6, 9,10,11,12,13]. Research suggests that home-based rehabilitation is effective [14]. This can lead to greater satisfaction amongst stroke survivors, reduced caregiver strain, and reduced hospital readmission rates and length of stay [15].
Telerehabilitation, the delivery of rehabilitation using technology, and use of remote monitoring sensors can be beneficial for patients due to their ability to support access to services where clients face limitations to attending in person, e.g. in cases of geographical isolation [16]. Telerehabilitation facilitates patients as they engage with rehabilitation in their own time and space [17], and has been suggested to promote engagement with rehabilitation practices [18]. These services can offer the most benefit where they include access to information and feedback about lifestyle, risk factor modification, and therapy for addressing the impairments resultant from stroke. In stroke, telerehabilitation is currently used to support areas like mobility, speech, and cognition, and can build stroke survivors’ confidence with these activities [18].
The development of markerless motion capture technology, which uses a single camera to measure the ability to move or carry out functional tasks, could further support remotely delivered telerehabilitation for motor recovery and the physical effects of stroke. Measurements taken by the system can be used to provide feedback on a patient’s performance which is helpful to the patient and treating clinician. Feedback can be delivered in real-time or on completion, depending on the associated software platform capabilities [19,20,21,22]. Compared to marker based or markerless systems comprised of multiple cameras, single camera, markerless systems are easy to setup, particularly if they are run through a single device. They are also portable, less expensive, need a smaller capture volume and do not require physical examinations for marker placement or anthropometric measurements. The overall experience is more patient friendly and efficient for all concerned [19,20,21,22]. Single marker less camera systems could address existing access barriers associated with hospital-based services [19] and can more readily be integrated into existing care pathways and community settings. However, it is important that implementation of any technology into services does not further embed social health inequalities and is acceptable and feasible for the intended users and providers of the service [23].
The UK National Health Service (NHS) long-term plan sets out the requirement for a new service model for the 21st Century where digitally enabled care is considered mainstream across the health service [24]. These principles are reflected in the recent guidelines which recognise that technology could be used to augment existing delivery of stroke rehabilitation services. Integration of technology into rehabilitation practice through the development of effective telerehabilitation programs can extend the ability of patients to access stroke rehabilitation services and guidance remotely, compared to conventional rehabilitation models where guidance for an individual’s rehabilitation comes from in-person sessions with rehabilitation professionals [18]. The delivery of health services across the nation, including in acute and subacute stroke rehabilitation [25] and community-based rehabilitation services [26], have not fully recovered post the Covid-19 pandemic. These changes affected stroke care [27], restricting stroke survivors from accessing necessary services. As UK government policy continues to embrace digital facilities in the care pathway [28] and services are developed for digital use and delivery of complex interventions, it is important to gather evidence about the views and experiences of the intended users. Doing so ensures that the facilities meet user needs through engagement of stakeholders, identification of key uncertainties, intervention refinement, and consideration of the overall context in which the service and intervention are positioned [14].
This study is part of a wider project which hopes to develop an intervention for stroke rehabilitation within the community by integrating existing technology (markerless motion capture) in a new context (stroke rehabilitation in the community). The project considers current use of this technology in existing settings and explores how its attributes could be beneficial for stroke rehabilitation in the community, including key features which would also need to be considered when developing software using this technology in the future. This study aims to consider context, stakeholders, and key uncertainties in this area, exploring stroke survivor and physiotherapist attitudes towards the use of markerless motion capture technology within community stroke rehabilitation.
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