As new technologies enter the market or the research development track, physical therapists increasingly are in positions to either guide or lead the development team, working with engineers to adapt and modify existing technologies or develop new technologies to enhance rehabilitation, prevent decline, monitor change, or maintain healthy living. Remarkable breakthroughs have occurred in rehabilitation robotics,1–3 the brain-computer interface,4–6 virtual reality (VR)–based therapies,7–10 wearable sensors and monitors,11–13 and all forms of interactive media applications for rehabilitation and health behavior. There still are significant gaps in knowledge about how to best to use these technologies to reduce disability broadly, but we know that many of these technological developments provide the opportunity for new strategies and interventions to enhance quality of life for people with disabilities and chronic conditions that affect function and mobility:
- New technologies have the potential to reduce environmental barriers—for instance, “smarter” homes and buildings allow tasks to be performed with minimal human input, and mobility and communication equipment minimizes the impact of underlying impairments on activity and participation.
- Usual service delivery is enhanced by telerehabilitation, which facilitates training via the web, telephone, or other technology over great distances.
- The Internet and social media allow more people with (and without) disabilities to connect with one another and support each other in real time in a way that was impossible before.14
The physical therapy profession can be central to ensuring the development and optimal use of new technologies to reduce disability and enhance healthy living.
In preparing for PTJ‘s special series on innovative technologies for rehabilitation and health promotion, we were particularly interested in receiving contributions about current technologies that have the potential to accelerate progress in physical therapy and rehabilitation strategies, techniques, and interventions. We sought contributions that used both theoretically and empirically based principles to inform and enhance integrated interactive technologies and clinician-delivered rehabilitation solutions in collaboration with diverse end-users and professionals who have scientific, clinical, and engineering expertise. Only through these interdisciplinary approaches can we advance and strengthen the foundations of rehabilitation interventions and the seamless interface of rehabilitation and technology.15
This special series presents cutting-edge research and perspectives that capture the essential role that new technologies can play in physical therapy and rehabilitation practices globally. The articles showcase research and case reports from established authors, including physiotherapists/physical therapists from the United Kingdom, Australia, Israel, Canada, and the United States. In addition to the global perspective of our international authors, there is considerable interdisciplinary expertise across the articles, and the research teams include rehabilitation engineering, arts and technology, occupational therapy, physical therapy, medicine, and computer science.
The technologies and patient groups are equally diverse:
- Transcranial direct current stimulation (TDCS) for children with pediatric hemiparesis16
- Virtual reality following adult stroke10,17,18 and for children with developmental coordination disorders19
- A novel force sensor system for detecting progression in Parkinson disease20
- An iPhone exercise application in people with familial dysautonomia21
- A mixed reality or interactive neurorehabilitation system for stroke rehabilitation22
- Body-worn sensors for balance and gait rehabilitation23
In addition to the technology-focused research papers, there are 2 perspectives about social media. These authors present distinct yet important views about the role of social media in health care and health promotion. Knight and colleagues24 propose that incorporating social media in both the design and delivery of physical therapist care can enhance patient engagement in prescribed health behaviors and improve treatment outcomes, whereas Gagnon and colleagues25 explore the policy implications of organizational adoption of health care social media and propose individual opportunities and guidelines for social media use by the physical therapist.
As the physical therapy profession embraces the mobile health (mHealth) industry and learns to optimally adapt it to the patient’s needs and expectations, we must be guided by the evidence regarding mHealth technologies. Dicianno and colleagues26 describe the evolution of mHealth technologies and how mHealth is used to improve patient satisfaction, deliver care, and promote health and wellness—and they also discuss the regulatory and funding challenges to mHealth. Levac and colleagues27 address the development and preliminary evaluation of a knowledge translation resource to support clinical decision making pertaining to the use of Kinect™ games in physical therapy.
In light of the recent explosion of interactive immersive technologies, including VR and video games, the special series includes 3 distinct and important perspectives about the role and effective application of VR-based tools for rehabilitation:
- Levin and colleagues10 discuss how motor learning and motor control principles can be exploited by VR training environments, provide evidence concerning current applications for upper limb motor recovery in stroke, and identify the limitations and opportunities with respect to effectiveness and transfer of learning to daily life tasks.
- Proffitt and Lange18 contend that researchers must take a progressive, step-wise approach through the stages of intervention development using evidence-based principles, take advantage of recent data, and use standardized measurement tools in order to design effective VR interventions that can be assessed in carefully designed efficacy and effectiveness trials.
- Baran and colleagues22 present an interdisciplinary approach in the development and use of scalable interactive neurorehabilitation (INR) systems for upper extremity management of patients with stroke. They propose a coherent approach to INR design to facilitate the use of the systems by physical therapists, to increase the number of successful INR studies, and to generate rich clinical data that can inform the development of best practices for use of INR in physical therapy.
Most of the research presented in this series is early-stage feasibility or proof-of-concept level, and more than a few papers noted small sample size as a limitation. We could move out of our parochial comfort zone to consider joining forces with our colleagues globally—and use information technology communication networks to not only bring researchers, engineers, and clinicians together but to create rich shared databases that could be mined using sophisticated data mining techniques that are available only when there is a great deal of data.
Computer scientists already are “mining from time series human movement data.”28 Tseng and Cook use human walking data collected from volunteers to identify age categories and to detect possible changes in the individual’s health condition. They applied wireless accelerometer sensors similar to those described by Horak and her team23 in this special series. Some time ago, Mulroy and colleagues29 used cluster analysis for gait pattern classification of patients in the early and late recovery phases following stroke. Horak and colleagues highlight the importance of obtaining impairment-level metrics of balance and gait from body-worn sensors to better characterize how and why functional performance is impaired. Furthermore, the use of body-worn sensors presents opportunities (and challenges) for monitoring participation in home exercise programs and for capturing the quality of natural mobility in the community.
As these technologies become smarter, and as they are connected through wireless communication, more possibilities than we could have ever have imagined will open up to advance the science. There is little doubt that advanced technologies will be a major player in the future of rehabilitation and physical therapist practice. It is fair to say that we are nearing the end of the beginning
Increasing evidence within the last 20 years has shown that the injured central nervous system (CNS) has the ability to reorganize. Reorganization in a functional meaningful way is dependent on motor activity as executed during rehabilitative training, and is followed by functional improvements. Robots for neurorehabilitation were designed as possible tools for therapists to automate labor-intensive training techniques, especially at an early stage where patients require a high amount of support. Because of their programmable force-producing ability, robotic devices can support the patient during task oriented movements, thereby providing correct afferent feedback while reducing the physical effort for the therapist. Robots can replicate some features of a therapist’s manual assistance, allowing patients to semi-autonomously perform their movement training. Novel therapy devices can furthermore increase the duration and number of training sessions while reducing the number of therapists required for each patient. Augmented Performance Feedback scenarios increase patients’ motivation and compliance thereby increasing active participation. Besides enhancing the rehabilitation process and improving therapeutic outcome, new technologies have the potential to support clinical evaluation, precisely control and measure therapy and implement novel forms of mechanical manipulation impossible for therapists to simulate.
For more than 8 years we asked people with disabilities, senior citizens, people in need of care and their relatives in northern Germany about the IRMA trade fair offer. 98% of you recommend our fair to others, are happy about the IRMA offer and want to continue using the fair as an information, comparison and procurement portal.
Although the many advantages of a rehabilitation trade fair are obvious, very few trade fair visitors are willing to travel long distances, for example to comparable trade fairs further away. 80 to 90% (depending on the survey year) of the visitors state that they want to take advantage of a trade fair, but do not want to take more than 200 km to get there. With this distance, the Irma covers the whole of northern Germany. The north was long “chronically” undersupplied, which is why the “IRMA” concept prevailed.
IRMA is a trade fair for consumers. Here the customer decides which products will prevail on the market and what is best for him. For people with disabilities, it is extremely important to have comparative options when choosing aids. Because local suppliers cannot always deliver the optimal products. Visitor quote: “Here we finally had the chance to choose the best for us from the many offers from all over Germany”.
The IRMA is a trade fair for people with disabilities, wheelchair users, senior citizens, those in need of care and their relatives.
It offers the people of northern Germany everything that can make life easier for people with restrictions and increase their independence.
Innovative products and services from over 130 exhibitors from Germany and around the world are waiting for you here.
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