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real-time remote monitoring of motor performance;
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remote calibration of rehabilitation protocol parameters.
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Exoskeleton-like machines.
Exoskeletons are wearable biomechatronic systems that
follow the limb movement of the subject. In this case the human-machine interface is
extended all along the limb (or its part of interest) and the number of degrees of
freedom (DOFs) of the machine is at least the same as that of the joints on which the
therapy is expected to produce an effect. The motor exercise can be directly defined in
the joint space and for this reason these machines are very complex. However, they
seem to be useful for severely disabled people whose natural synergies have been
significantly altered and there is a need for separate control of the different joints in
order to restore the natural motor-control strategies.
Exoskeletons for upper/lower limbs A.A. Rehabilitation
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compliant physical interaction along the whole limb kinematic chain;
neural control and biofeedback.
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2.1.3.
Support for multi-disciplinary care teams
A vital part of home care is the involvement of several care givers from multiple
disciplines who should ideally offer integrated care to the client. Since the care givers
are often alone at the home of the client, they must cope with any situation that arises
on their own and have access to the actual data of the client. This responsibility and
solitary decision making are major strains on care givers as expert interviews have
shown
3
. A support system for care personnel that allows remote consultation with
experts and decision support systems using all available information can significantly
reduce stress for care givers, increase the quality of care and allow a better use of
specialists. Scenario 2 sketches the most important features of such a support system.
Such a system should also support the interacting processes (workflow) of the different
care givers and the client as well.
By using tele-monitoring, medication management, and activity management and
monitoring systems together with tele-consultation, tele-medicine and decision support,
completely new ways of home care are possible, where also complex medical
treatments can be undertaken by care givers under the supervision of a remote
professional (see Figure 3).
Similar mobile systems have already been developed for a different application
area, for service technicians at the German railway company Deutsche Bahn and airline
companies.
Organizing care (professional and informal).
When organizing care, it needs to
be realized that the task cannot be undertaken without giving time and thought to the
elements of best practice and efficiency. It is vital to ensure best practice when many
different services are offered to help older people to continue to live independently at
home. There are many ways in which best practice can be defined but the point of
view of the older person and his or her helpers must be considered most of all.
3
The interviews referred to were conducted with experts from the Swiss care organization “Spitex”, which is
responsible for all care in Switzerland.
