TeleExergame: An Interactive Tele-Rehabilitation Platform for Improving Motor Function in Older Adults with Cognitive Deficit

TeleExergame：用于改善认知缺陷老年人运动功能的交互式远程康复平台

• 批准号: 10010290
• 负责人: Bijan Najafi
• 金额: $ 45万
• 依托单位: BIOSENSICS, LLC
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2022-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10010290
• 关键词: Address; Adherence; Adopted; Adult; Affect; Algorithms; Ankle; Balance training; Body measure procedure; Caregivers; Clinical Research; Clinical Trials; Code; Cognition; Cognitive; Cognitive deficits; Collaborations; Control Groups; Crural Paresis; Dementia; Development; Dropout; Effectiveness; Elderly; Enrollment; Equilibrium; Exercise; Exhibits; Feedback; Focus Groups; Frequencies; Goals; Health; Health Insurance Portability and Accountability Act; Home environment; Impaired cognition; Individual; Instruction; Intervention; Interview; Joints; Leg; Measures; Medical Device; Medicine; Memory; Mental Depression; Modeling; Monitor; Motivation; Motor; Movement; Musculoskeletal Equilibrium; Outcome; Parkinson Disease; Participant; Patient Care; Patient Monitoring; Patients; Perception; Performance; Phase; Population Group; Positioning Attribute; Posture; Psychosocial Assessment and Care; Publishing; Randomized; Rehabilitation therapy; Risk; Running; Sampling; Schedule; Small Business Innovation Research Grant; Supervision; System; Tablets; Target Populations; Technology; Telemedicine; Time; Training; Transportation; Visual; Weight; amnestic mild cognitive impairment; base; cohort; college; comorbidity; design; diabetic; exercise intervention; exercise program; exercise training; exergame; experience; fall risk; fear of falling; foot; frailty; functional disability; functional restoration; handheld mobile device; improved; interest; kinematics; mild cognitive impairment; motor function improvement; motor learning; patient population; physical therapist; primary outcome; programs; prototype; recruit; research clinical testing; satisfaction; sensor; stroke survivor; success; telehealth; telerehabilitation; virtual; visual feedback; wearable sensor technology

ABSTRACT Many individuals with mild cognitive impairment (MCI) and/or mild dementia experience both cognitive deficits and decline in motor function and postural balance. This results in an increased risk of falls. Conventional balance programs are not tailored for patients with cognitive impairment. Motor-cognitive exercises that are developed for these patients can be effective, but these rehabilitation programs are underutilized. Many patients who were referred exercise programs never attend; even fewer complete prescribed programs. For patients with cognitive impairment, transportation and scheduling are some of the key challenges that limit their adherence and commitment. However, unsupervised in-home exercise programs are not adequate for these individuals because of poor adherence, apathy, and inability to follow exercise instructions. Therefore, there is a need for a remotely- supervised in-home exercise program for older adults with MCI and/or mild dementia. To address this need, we propose to develop a tele-exercise system that allows a qualified therapist to remotely supervise and interact with the patient during goal-oriented game-like and low risk exercise tasks (TeleExergame) that have been designed to improve balance and cognition. The exercises are interactive balance tasks with explicit goal-oriented augmented visual feedback (i.e., the patient’s movement controls a virtual object on the screen, thus providing real-time visual and audio feedback that is critical for engagement and motor learning). This is achieved by a wearable sensor worn on a body segment of interest (e.g., shin) that measures body joint kinematics (e.g., position of foot/ankle during a virtual obstacle crossing task). For this Fast-Track submission, we conducted a preliminary study in a cohort of 22 patients with amnestic MCI, which demonstrated the effectiveness of the proposed Exergame training paradigm in the target population. In Phase I, we will create the first prototype of an easy-to-use Exergame solution for in-home use that includes a telemedicine interface to assist the patient or his/her caregiver with sensor positioning, running the program, remote supervision, and monitoring of the patients during exercise. We will evaluate the feasibility, perception of benefit, and ease of use of the proposed system in the target population and focus group of therapists. In Phase II, we will complete the development of the TeleExergame system to enable HIPAA compliant remote supervision by a qualified therapist and provide quantitative metrics for remote monitoring and personalization of the exercise program by the therapist. We will then conduct a clinical study to evaluate the efficacy of the solution. The proposed interactive tele-rehabilitation system would have an immediate and appreciable impact on patient care by providing an interactive exercise program for individuals with MCI and/or mild dementia. However, MCI and dementia represent only a fraction of the potential market for the proposed technology, which could also be used in other patient populations that exhibit poor balance, such as Parkinson’s disease, diabetics, stroke survivors with lower-extremity paresis, and older adults who cannot perform conventional exercises.

抽象的 许多患有轻度认知障碍 (MCI) 和/或轻度痴呆的人都会经历这两种认知缺陷 运动功能和姿势平衡能力下降，这会导致跌倒的风险增加。 所开发的计划并非针对认知障碍患者量身定制。 对于这些患者来说可能是有效的，但这些康复计划并未得到充分利用。 对于患有认知障碍的患者，从未参加过推荐的锻炼计划；甚至更少完成指定的锻炼计划。 障碍、交通和日程安排是限制他们遵守和安排的一些关键挑战 然而，无人监督的家庭锻炼计划对于这些人来说是不够的，因为 依从性差、冷漠且无法遵循锻炼指示，因此需要远程指导。 针对患有 MCI 和/或轻度痴呆症的老年人的监督家庭锻炼计划。 为了满足这一需求，我们建议开发一种远程锻炼系统，允许合格的治疗师远程进行 在以目标为导向的游戏式和低风险运动任务中监督患者并与患者互动 （TeleExergame）旨在提高平衡和认知能力。这些练习是互动的。 通过明确的目标导向的增强视觉反馈来平衡任务（即患者的运动控制 屏幕上的虚拟对象，从而提供对于参与至关重要的实时视觉和音频反馈 这是通过佩戴在感兴趣的身体部位（例如胫骨）上的可穿戴传感器来实现的。 测量身体关节运动学（例如，虚拟越障任务期间脚/脚踝的位置）。 对于本次快速通道提交，我们对 22 名遗忘性 MCI 患者进行了一项初步研究， 这证明了所提出的 Exergame 训练范式在目标人群中的有效性。 第一阶段，我们将创建第一个易于使用的 Exergame 解决方案原型，供家庭使用，其中包括 远程医疗界面可帮助患者或其护理人员进行传感器定位、运行程序、 我们将评估运动期间患者的可行性和感知。 所提出的系统在目标人群和治疗师焦点群体中的益处和易用性。 II、我们将完成TeleExergame系统的开发，以实现符合HIPAA标准的远程监管 由合格的治疗师进行，并提供用于远程监控和个性化锻炼的定量指标 然后我们将进行临床研究来评估该解决方案的功效。 拟议的交互式远程康复系统将对患者产生直接且明显的影响 通过为 MCI 和/或轻度痴呆症患者提供互动锻炼计划来进行护理。 痴呆症仅占拟议技术潜在市场的一小部分，这也可能是 用于其他平衡能力较差的患者群体，例如帕金森病、糖尿病、中风 下肢瘫痪的幸存者以及无法进行常规锻炼的老年人。