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: 10582020
• 负责人: Bijan Najafi
• 金额: $ 124.63万
• 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 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10582020
• 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; Impaired cognition; Individual; Instruction; Intervention; Interview; Joints; Leg; Measures; Medical Device; Medicine; Memory; Mental Depression; Modeling; Motivation; Motor; Movement; Musculoskeletal Equilibrium; Outcome; Parkinson Disease; Participant; Patient Care; Patient Monitoring; Patients; Perception; Performance; Persons; 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; efficacy evaluation; 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; remote monitoring; research clinical testing; satisfaction; sensor; stroke survivor; success; tele-exercise; 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/或温和痴呆的人都经历了两种认知缺陷 和运动功能和姿势平衡的下降。这导致跌倒的风险增加。常规平衡 程序不是针对认知障碍患者量身定制的。开发的运动认知练习 因为这些患者可能是有效的，但是这些康复计划未被充分利用。许多患者 推荐的锻炼计划永远不会参加；完全规定的程序更少。对于认知患者 损害，运输和调度是限制其遵守性和的一些关键挑战 承诺。但是，无监督的家庭锻炼计划对这些人来说不足，因为 依从性，冷漠和无力遵循锻炼指示。因此，需要远程 为患有MCI和/或轻度痴呆的老年人监督家庭运动计划。 为了满足这一需求，我们建议开发一个远程运动系统，以允许合格的治疗师远程 在以目标为导向的游戏和低风险锻炼任务中监督和与患者互动 （teleexergame）旨在改善平衡和认知。练习是互动的 平衡任务与明确的目标增强视觉反馈（即，患者的运动控制A 屏幕上的虚拟对象，因此提供了实时的视觉和音频反馈，这对于参与至关重要 和运动学习）。这是通过戴在感兴趣的身体部分（例如胫骨）上的可穿戴传感器来实现的 测量人体关节运动学（例如，在虚拟障碍物交叉任务中脚/脚踝的位置）。 对于这次快速提交，我们在22例炎症MCI患者的队列中进行了初步研究， 这证明了拟议的Exergame培训范式在目标人群中的有效性。在 第一阶段，我们将创建一个易于使用的Exergame解决方案的原型 远程医疗界面以帮助患者或他/她的护理人员使用传感器定位，运行程序， 远程监督和在运动过程中监测患者。我们将评估可行性，感知 在目标人群和焦点治疗师中，拟议系统的好处和易用性。在阶段 ii，我们将完成Teleexergame系统的开发，以实现符合HIPAA的远程监督 由合格的治疗师，并提供定量指标，以远程监控和个性化练习 治疗师计划。然后，我们将进行临床研究以评估溶液的效率。 拟议的互动远程纠正系统将对患者产生直接和可观的影响 通过为MCI和/或轻度痴呆症患者提供互动锻炼计划来护理。但是，MCI 痴呆症仅占拟议技术潜在市场的一小部分，这也可以是 在其他暴露较差平衡的患者人群中使用，例如帕金森氏病，糖尿病患者，中风 较低肢体的幸存者和无法进行常规练习的老年人。