The emerging role of Microsoft Kinect in physiotherapy rehabilitation for stroke patients

Original Editor - Karen Feeney, Kate Reidy, Nicole Bell, Sally Wood and Joanne Knowles as part of the QMU Current and Emerging Roles in Physiotherapy Practice Project

Top Contributors - Sally Wood, Kate Reidy, Nicole Bell, Karen Feeney, Hannah Meredith, Leana Louw, Kim Jackson, Joanne Knowles, Naomi O'Reilly, 127.0.0.1, Admin, Chee Wee Tan, Evan Thomas and Michelle Lee  

 Introduction:Where it all began

1.0 Introduction

The median age of the general population is projected to significantly rise in upcoming years. This causes much added stress for clinics and hospitals. Stroke is a significant risk factor with age and the need for new rehabilitation is on demand. Technology and its advanced methods are continuously being assessed so that they can be used in a private, home-based setting while still providing rehabilitation instructions and progress tracking. This area of rehabilitation technology is expected to expand and will do so over the current year's 

(Levac et al., 2014).

Research study resoure: expansion of rehabilitation technology Systematic review of Kinect applications in elderly care and stroke rehabilitation

Virtual Reality, is a clinically validated physical rehabilitation system based on video games and motion capture technology. It was developed to treat patients suffering from various conditions and pathologies. Neurodegenerative disease (Multiple Sclerosis & Parkinson's disease) Neuromuscular disorders ( Dystrophies, myopathies) and Neurovascular disorders/Trauma (Stroke and traumatic brain injuries) also to improve mobility of the elderly.

The result was a game developed in 2012 in Virtual Rehab to test out the possibilities of using video games as a complementary rehabilitation tool. The patient interacts with the system in a 3D environment, where they perform multiple movement combinations without the need of an attached device or a controller thanks to the Kinect.

VirtualRehab is tackling major issues related to rehabilitation. Not only is it providing a rehabilitation service which improves adherence to treatment by adding fun and entertaining features, but it also reduces the high cost associated with traditional rehabilitation making it more affordable and accessible to everyone.

Ideally, all stroke rehabilitation exercises would be performed with a therapist in a clinical setting on a daily basis with a recommended session of 45min per patient. However, this demand within hospitals is becoming increasing difficult and logistically impractical.

Microsoft Kinect is the forerunner in commercially available hardware in which development of these new technologies can be built. Information on how it works? What is does? And an insight into Virtual Rehab developed by Microsoft Kinect for the use of stroke patients will be discussed.

Words: Microsoft Kinect, Virtual Rehab, Rehabilitation, Stroke

 

Audience

This resource is designed to provide physiotherapists with an insight into Microsoft Kinect and its use in stroke rehabilitation. 

Learning outcomes 

L1 - Identify and justify the knowledge and reasoning behind the use of motion sensor technology in physiotherapy practice for the rehabilitation of stroke patients.
L2 - Critically evaluate the evidence behind motion sensor technology in the rehab of stroke patients
L3 - Justify the use of Microsoft Kinect and how this benefits patient outcomes.
L4 - Outline the key knowledge physiotherapists will need to work with motion sensor technology in the rehab of stroke patients in the future

What is Microsoft Kinect 

Kinect derived from the meaning of the word kinetic (meaning to produce movement).

Microsoft's Kinect is described as a "controller-free gaming and entertainment experience" and is commonly sold bundled with the Xbox 360. However, to see it as only a way to play games would underestimate its significance and brilliance.

A computer based gaming systems such as Microsoft Kinect (Kinect), can facilitate complex task practice, enhance sensory and motor feedback, and provide visually observed technique for the user.

The Kinect is currently the hardware that provides developers with the greatest opportunities for innovative programs - for both games and applications.

Essentially this hardware is a box with some cameras that makes use of infra-red (IR) illumination to obtain depth data, colour images and sound. The Kinect system can identify players through face and voice recognition. Kinect can "see" in 3-D and creates a skeleton image of the player and a motion sensor detects movement.

Demands placed on physiotherapy rehabilitation services 

Stroke occurs approximately 152,000 times a year in the UK; that is one every 3 minutes 27 seconds (State Association., 2015). As people are living longer the number of sufferers will continue to increase, making cost effective community rehabilitation a higher priority. Stroke is the largest cause of complex disability with half of stroke survivors being left with residual disability. Globally the challenge of providing quality, affordable health care has never been so crucial in stroke rehabilitation. The number of sessions that stroke survivors attend are limited to the availability of a clinic close to their residence and the amount of time friends and family can devote to help them commute, as most are incapable of driving.With the high prevalence rate of stroke this puts increased demand on physiotherapists to treat each patient both in hospital and after discharge. Although many people with stroke receive early rehabilitation, many are left dissatisfied with the way they are followed up and the level of rehabilitation provided in the year following the stroke. Due to time restraints and prioritisation of patients they can be pushed further down the rehabilitation follow up list. Another challenge to effective rehabilitation is insufficient completion of rehabilitation exercises by patients which severely reduces the potential outcome of overall motor recovery. Exercises are often unpleasant, and tedious leading to patient's tolerance for exercise to decline. Patients are often dependent on one-to-one rehabilitation services provided by physiotherapists to help regain their functional ability. It is widely recognised that a strong rehabilitation service is the most effective and efficient way of addressing these growing issues which can be addressed through technologically advanced methods.

How Microsoft kinect can help

Microsoft kinect can: :

• Provide flexibility in delivering individualised physiotherapy in the patient's home.
• Involve carers more within the rehabilitative process.
• Help the NHS meet National Clinical Guidelines on physiotherapy interventions for stroke suffers (45 minutes per day of treatment during the acute phase).
• Improve patient engagement through stimulating rehabilitation.
• Be a low cost rehabilitation tool.
• Reduce the need for expensive one-to-one clinical contact.
• Provide a range of indirect savings due to improved rehabilitation of patient.
  

Question Time

1. Name three ways in which Microsoft Kinect can help in the rehabilitation of stroke patients
2. What are the main contributing factors which increase demands on the healthcare system at present?
3. What is the recommended daily treatment time for patients in the acute phase of stroke rehabilitation?
   

Stroke and the need for intensive rehabilitation

Physiotherapy plays a key role in the rehabilitation of those affected by stroke and is needed in order to aid patients through their journey of recovery. Physiotherapy in stroke rehabilitation typically aims to strengthen and retrain muscles to regain lost limb function and improve quality of life.

Through studies of motor learning and motor control evidence shows that for effective learning and muscle re-education to take place practice of exercises needs to be intensive and frequent (McBean et al 2013). The most rapid recovery occurs within the first 3 months post stroke and therefore during this time frame patients need intensive rehabilitation therapy. Unfortunately, currently in most NHS hospitals stroke patients receive approximately 7.5hours of physiotherapy rehabilitation per week and when discharged patients receive on average 1-2 hours of community rehabilitation per week. Additionally, the current Early supported discharge (ESD) plan, for stroke patients with mild to moderate disability, only runs for on average 6 weeks (Stroke Association, 2015). Due to the current economic status of the NHS this is not likely to improve therefore more intensive rehabilitation strategies need to be introduced in order to improve outcomes for stroke patients.

Patients are being discharged from hospital earlier and earlier as there is a need to free up hospital beds which often leaves patients with fewer hours of physiotherapy rehabilitation. There is therefore a need for cost effective, intensive home based physiotherapy programmes which retrain and re-educate muscles in stroke patients.

Is Microsoft Kinect the answer?

Microsoft Kinect allows intensive stroke rehabilitation to take place in the home environment as well as taking pressure off health providers as patients can perform this type of rehabilitation on there own.