REMOTE REHABILITATION OF STROKE PATIENTS

Rafal Wcislo, Jacek Kitowski, Michal Wrzeszcz

Department of Computer Science, AGH University of Science and Technology, Cracow, Poland

Janusz Otﬁnowski, Karolina Probosz

Collegium Medicum, Rehabilitation Clinic, Jagiellonian University, Cracow, Poland

Artur Sobczyk, Malgorzata Pisula

University Hospital, Rehabilitation Institution, Cracow, Poland

Keywords:

Stroke, Remote rehabilitation, Computer-aided rehabilitation, Multimedia rehabilitation, Telemedicine.

Abstract:

In the paper we present a concept of remote rehabilitation of stroke patients. Rehabilitation plays a vital role

in helping stroke survivors partly or fully recover their functions lost after brain injury. The duration of the

rehabilitation plays a crucial role. We believe that many of common disabilities that result from a stroke can

be treated at patients’ homes with the use of a specially designed computer system. The architecture of the

system is presented as well as its main goals and assumptions.

1 INTRODUCTION

Stroke may have a clear-cut negative impact on pa-

tients’ psychosocial functioning. There are common

disabilities that result from a stroke: decline in at-

tention, selective attention deﬁcits, decline in logi-

cal thinking, planning and reasoning tasks, compre-

hension, synthesis and analysis, weakening of short-

term as well as long-term, verbal and visual memory,

speech disorders (aphasia, dysarthria).

Rehabilitation plays a vital role as it helps the

stroke survivors partly or fully recover their functions

lost after brain injury.

Not only does the choice of proper exercises play

a vital role as well as their correct and systematic per-

formance but the duration of rehabilitation is gener-

ally of utmost importance. It should be as long as

possible. On the other hand, prolonging rehabilita-

tion in the rehabilitation centre is expensive and it

takes another patient’s seat. That is the reason for our

claim that after the rehabilitation in the clinic the pa-

tient should undergo further rehabilitation at home.

The research presented in (Jack et al., 2001;

Broeren et al., 2002; Merians et al., 2002; Sveistrup

et al., 2003; Otﬁnowski et al., 2006) proved that the

implementation of computer systems specially de-

signed for rehabilitation purposes speeds up stroke

patients’ recovery. Using multimedia in post-stroke

rehabilitation makes the therapy process more inter-

esting. It also motivates patients and makes them

deeply involved in the rehabilitative therapy as it pro-

vides an additional stimuli for their hard and long

work. The reported results reﬂect enhancement of

our previous development in this ﬁeld (Kitowski et al.,

2009; Wcislo et al., 2009; Probosz et al., 2009; Szom-

bierski, 2009; Wcislo et al., 2010).

The aim of the project presented in this article is to

adjust the computer rehabilitation program in such a

way as to make it possible for patients to use at home.

Some patients are able to continue their rehabilitation

under the supervision after leaving the clinic. The

doctors are provided with full insight into patients’

performance of exercises having the possibility to re-

motely control and modify the parameters of the re-

habilitative program.

2 COMPUTER-AIDED

REHABILITATION

2.1 Rehabilitation Stages

Post-stroke rehabilitation consists of four stages:

500

Wcislo R., Kitowski J., Wrzeszcz M., Otﬁnowski J., Probosz K., Sobczyk A. and Pisula M..

REMOTE REHABILITATION OF STROKE PATIENTS.

DOI: 10.5220/0003131605000503

In Proceedings of the International Conference on Health Informatics (HEALTHINF-2011), pages 500-503

ISBN: 978-989-8425-34-8

 2011 SCITEPRESS (Science and Technology Publications, Lda.)

Figure 1: Sample exercises.

• Stage 1: Diagnostics. Types and levels of dis-

ability are estimated on the ground of neurologic

examination and psychological tests.

• Stage 2: The Main Rehabilitation Stage. The

patients perform adequately chosen exercises

within approximately three months’ time.

• Stage 3: Goal Attainment Scaling. A patient un-

dergoes diagnostic evaluation that assesses their

progress.

• Stage 4: Remote Rehabilitation. Chosen pa-

tients might continue rehabilitation at home – an

individualized computer application is prepared

for them that lets the doctors monitor the patients’

exercises via the Internet. The doctors might also

make some changes in the performed tasks.

2.2 Exercises and Trainings

More than 25 rehabilitation exercises have been pre-

pared and veriﬁed by psychologists and therapists to

target at different disabilities:

• logopedic exercises for patients affected by vari-

ous forms of aphasia,

• exercises that help retrain stroke-impaired limbs,

• exercises improving cognitive functions (com-

prehension, association, concentration, memory,

etc.).

Some of the exercises take into account more than

one disability at a time. Figure 1 shows screenshots of

sample exercises. Patients perform the exercises with

the use of a joystick, Virtual Reality, a parapodium

gloves or a keyboard.

The therapy consists of clearly designed exercises

– the exercise quantity and the order of exercises are

strictly designated by the training programme. The

difﬁculty level is controlled by exercise parameters.

The parameters are selected in such a way that the

exercises are neither too difﬁcult (in order not to dis-

courage the patients), nor too easy. During the ther-

apy the computer system stores all the parameters and

the patient’s results (e.g. the duration of exercise, the

number of mistakes). It lets a doctor supervise a pa-

tient’s progress and, if necessary, modify the exercises

and training.

3 REMOTE REHABILITATION

Not all of the patients are able to take part in the re-

mote rehabilitation process. Choosing the proper pa-

tients depends on various factors such as medical rea-

sons (e.g. not all of the rehabilitative exercises may

be performed without a professional supervision) or

the necessity of being the owner of a personal com-

puter and having assistance of somebody who is able

to operate the rehabilitation application.

The access to the Internet is not necessary in order

to perform the exercises. However, the lack of the

Internet access signiﬁcantly limits the possibilities of

the system. A graphical user interface of the software

installed on a patient’s computer is to be identical with

the one that the patient worked on while staying in the

clinic. It will facilitate the start of a rehabilitation at

home. The system is characterized by the following

activities or features:

• The program installed at patient’s home sends the

achievement scores to the clinic immediately after

REMOTE REHABILITATION OF STROKE PATIENTS

501

Figure 2: System architecture.

the completion of each exercise, or – if there is

no access to the Internet– as soon as the Internet

connection is established.

• On the grounds of patient’s scores a doctor is able

to change the parameters of the exercises and the

trainings so that they can meet the requirements of

the rehabilitation better. These modiﬁcations are

automatically sent to the patient’s application via

the Internet.

• Considering the necessity to keep the personal

data conﬁdential and secure the transmission be-

tween the rehabilitation program and the clinic is

encrypted and authenticated bilaterally on the ba-

sis of the previously generated (in the clinic) cer-

tiﬁcates. The login and the password are remem-

bered due to automatic authentication of the pa-

tient.

• Due to the same reasons the client’s application

are devoid of personal details or the information

about the disease since such data is stored only in

the rehabilitation centre.

Additionally, a simultaneous audio-video connec-

tion between a doctor and a patient during the exercise

performance is anticipated. The doctor will watch the

patient doing the exercise on one’s computer screen

and will be able to provide additional explanation or

give another piece of advice.

As the number of patients shall grow due to the

necessity of dealing with the remote patients, the ad-

visory system that aids rehabilitation doctors shall be

developed as well. The doctors will be able to get

immediate information on each patient including the

data about their exercise progress. The system shall

automatically highlight the fact that a patient omits

certain exercise or does it too rarely; it will also in-

dicate if any exercise is performed too easily or is of

great difﬁculty to a patient.

What seems to be a more difﬁcult challenge is the

implementation of the procedures that could propose

the modiﬁcation of exercises on their own (e.g. by

making the exercises more difﬁcult) if there is a long

break in the Internet connection between a clinic and

a patient. It would surely stimulate the patient more

and make it possible to avoid the monotony.

4 SYSTEM ARCHITECTURE

Figure 2 presents the architecture of a computer sys-

tem used in post-stroke rehabilitation. Its most impor-

tant components are as follows:

• A database server that stores patients’ details, pa-

tients’ trainings, parameters of exercises and all

of their achieved scores (performance duration,

number of mistakes, screenshots, a set of parame-

ters for which the exercise is performed).

• A remote services server for communication with

patients’ programs activated outside the clinic.

• Client applications intended for the doctors to fol-

low the patients’ progress and modify the exer-

HEALTHINF 2011 - International Conference on Health Informatics

502

cises and trainings. Already existing trainings

might also be used as templates for creating train-

ings for new patients – what really facilitates the

preparation of a rehabilitation program.

• Rehabilitation applications that are located in the

clinic and in the patients’ house. They are used

for performing the rehabilitation.

All applications are written in C++ using Nokia

Qt environment and libraries. As the database server

MySQL RDBM system is used.

5 EXPLOITATION NOTICE

The rehabilitation system is in the routine local op-

eration in the Rehabilitation Clinic, CM UJ. Accord-

ing to the tests (Wcislo et al., 2010) for both apha-

sia disease and concentration and memory dysfunc-

tion important improvement of patients’ ability was

observed. The pilot version of the system for the re-

mote rehabilitation (section 3) has already been vali-

dated functionally, proving its reliable operation.

6 CONCLUSIONS

The research has proved the usability of a computer-

aided rehabilitation. However, the duration of the re-

habilitation plays a crucial role and it is not advisable

to ﬁnish it after three months. We hope that the remote

rehabilitation shall make it possible for many patients

to continue their treatment at home and it shall inﬂu-

ence their full recovery.

Our future work will be focused on paradigms of

exploration of the existing data kept in the relational

database system in order to extract knowledge con-

cerning a rehabilitation process of each patient sepa-

rately. The knowledge will be further used for deﬁn-

ing patients’ proﬁles to be used by a kind of advice

system for both medical doctors and patients. Its role

will be to generate hints autonomously on the basis

of extracted knowledge for the doctors and patients

concerning continuation of the rehabilitation process.

ACKNOWLEDGEMENTS

This research is ﬁnanced partially by Polish Min-

istry of Education and Science, Project No. N N519

315435 and by the AGH grant No. 11.11.120.865.

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