Biomedical Engineering Reference
In-Depth Information
execution of the clinical trials (Hermens et al. 2007), prototype portable units were used
with the same functionality as the Nu!Reha platform (not engineered, certified and aes-
thetically refined). The users in the trial were recruited from groups of multiple sclerosis
(MS), traumatic brain injury (TBI), and stroke patients (because the system was originally
conceived for neurological rehabilitation). The inclusion criteria were
1. Age over 18 years;
2. Established diagnosis of MS, stroke, or TBI;
3. Taking more than 25 s to perform the nine-hole peg test;
4. Ability to move at least one peg in 180 s during the nine-hole peg test;
5. Sufficient autonomous functioning;
6. Internet connection or telephone line and reachable Internet provider;
7. Stable clinical status; and
8. Living at home.
The third and the fourth criteria include only users whose arm abilities were in the mid-
range between severe impairment and little impairment because these criteria make use
of a recognized clinical evaluation tool, which consists of a nine-hole matrix in which pegs
of specific dimensions should be inserted. The exclusion criteria were
1. Disturbed upper limb function not related to MS, TBI, or stroke;
2. Serious cognitive and/or behavioral problems;
3. Serious emotional problems;
4. Major visual problems;
5. Communication problems;
6. Medical complications; and
7. Other problems possibly contraindicating autonomous exercise at home.
The scheme of clinical trials was based on the ABA application of the telerehabilitation
tool for the intervention group, comparing the results from the control group. The duration
chosen for the application of rehabilitation at home was four weeks, which was considered
sufficient to reveal the effects of the proposed activities. Figure 16.5 is the flow chart of the
experimental design.
T0 is the first assessment, after the application of the inclusion criteria, after which users
were randomly assigned to the intervention or control group. At T1, a second assessment
was provided (after a period of 1 month), whereas at T2 an assessment after 1 month of
telerehabilitation activity (intervention group) was performed.
16.3.5.1 Results and Discussion
The experimental trial included 47 men and 34 women with an average age of 48 years.
They were distributed among the three impairment causes (16 stroke, 30 TBI, and 35 MS).
At the end of the trial it was shown that the intensity of treatment (control group with usual
care versus intervention group with telerehabilitation) was nearly the same (9 h/month
versus 9.5 h/month). It is outside of the scope of this chapter to investigate and describe
specific assessment tools utilized or to go into a detailed analysis of the assessment results
