Emerging Technologies in Rehabilitation for Complex Injuries and Conditions

Original Editor - Wanda van Niekerk based on the course by Jason Giesbrecht

Top Contributors - Wanda van Niekerk and Jess Bell  

Importance of Innovative Technology in Rehabilitation[edit | edit source]

Innovative technology has grown substantially in the rehabilitation setting. Rehabilitation professionals are often involved in testing, developing and modifying new and existing technology alongside engineers and development teams. These innovations can improve rehabilitation, prevent decline and regression, monitor changes and help maintain healthy living. The ultimate aim of innovative technology is to improve the quality of life for individuals with complex injuries and conditions.[1]

Innovative technology has the ability to:

  • enhance the treatment and management of complex injuries and conditions
  • make rehabilitation more effective, efficient and patient-centred
  • reduce environmental barriers[1]
    • for example, smart home devices can perform tasks with little human input
    • innovative equipment can help decrease the impact of impairments on activity and participation
  • connect people and enable individuals to provide support to each other in real-time
    • for example, social media and internet support groups for people with similar injuries and conditions[1]

If innovative technology is to be effective for individuals with complex injuries and conditions, rehabilitation professionals need to stay up to date with the latest emerging technologies.

Emerging Technologies in Rehabilitation[edit | edit source]

Telerehabilitation[edit | edit source]

Telerehabilitation refers to the delivery of rehabilitation services by any rehabilitation professional through digital methods (i.e. information and communication technologies).[2][3] With the advances in communication technology, telerehabilitation has now become a viable option for delivery of rehabilitation services. As outlined in Table 1, its use and effectiveness have been tested in various complex injuries and conditions.

Table 1. Telerehabilitation research in complex injuries / conditions
Complex Injury/Condition Telerehabilitation Research
Stroke
  • Low- or moderate-quality evidence to suggest that telerehabilitation may not be inferior to in-person therapy and may, therefore, be a relevant model of service delivery to patients who need rehabilitation after stroke.[4]
  • Telerehabilitation is reported as a feasible and alternative method to conventional treatment or as a complementary treatment to improve treatment outcomes. Telerehabilitation has been shown to have good outcomes for motor and cognitive functions, aphasia and speech-linguistics in patients recovering from stroke. It may have positive effects on patient engagement and motivation.[5]
  • Telerehabilitation was found to be effective on patient satisfaction and clinical parameters, such as hand function and balance, in patients recovering from stroke.[6]
Multiple sclerosis
  • Telerehabilitation is reported to improve general quality of life, muscle strength and endurance in people with multiple sclerosis[6] and may be beneficial for the treatment of motor systems in people with multiple sclerosis.[7]
Parkinson's
  • Telerehabilitation may help improve balance and function[6] and maintain or improve gait, speech and voice, quality of life and patient satisfaction in people with Parkinson's.[8]
Spinal cord injuries
  • Telerehabilitation in the context of spinal cord injuries is referred to as teleSCI.[9] Recent research trends on teleSCI include preventive health and wellness after SCI, chronic pain management, anxiety and depression, restorative and rehabilitation care and disaster planning.[9] The benefits of teleSCI modalities are increased adherence and lower attrition rates, which may improve clinical outcomes.[9]
Traumatic brain injury
  • Evidence is still lacking on telerehabilitation in people with traumatic brain injury, but it may be a useful tool to facilitate and ensure continuity of care between hospital discharge and return to home.[10]
  • Read more: Telerehabilitation in Acquired Brain Injury[11]
Cardiopulmonary
  • Cardiopulmonary telerehabilitation is a safe and convenient alternative to in-person rehabilitation programmes. It improves patient participation by reducing barriers, such as logistics (e.g. transport) and finances. It includes remote monitoring, health coaching, patient education and social engagement, which may facilitate and improve patients' interest, participation and motivation.[12]
Musculoskeletal disorders
  • Telerehabilitation may improve health outcomes in people with musculoskeletal disorders.[13] It can improve patient engagement and provide efficient patient education opportunities. It has also been shown to be similar to in-person treatment in the reduction of pain and the improvement of function and quality of life.[14]
Burn injuries
  • Home-based telerehabilitation has been shown to be a safe and effective option for exercise programme delivery for patients with burn injuries ≤ 25% TBSA (total body surface area). Further research is required in patients with burn injuries and telerehabilitation.[15]
Post-operative rehabilitation
  • Telerehabilitation is feasible and effective in surgical patients compared to usual care. Patients showed an improved quality of life, but further research is recommended.[16]
Limb loss
  • Persons with amputation have specific and unique needs. This must be taken into consideration when providing telerehabilitation services. Ideally, the rehabilitation process for persons with amputation should involve a collaborative interdisciplinary team, so telerehabilitation should also be a team approach. The use of prosthetic limbs makes the provision of telerehabilitation services more complex. Special precautions may be necessary with virtual gait retraining if the person is new to wearing a prosthesis or where balance and coordination may be an issue.[17]

Benefits and Challenges of Telerehabilitation[edit | edit source]

Table 2. Benefits and Challenges of Telerehabilitation in Patients with Complex Injuries and Conditions
Benefits Challenges
Increased access to care Access to technology[18]
Reduced travel burden Privacy concerns[18]
Time-saving aspect with regards to travel time to the clinic but also taking time off from work to attend in-person appointments[17] Training for proper use and implementation (both patient and rehabilitation professional)[18]
Quicker/expedited access to care[17]
Provides opportunities for rehabilitation professionals to assess a person's needs within their home[17]

Virtual Reality Therapy[edit | edit source]

Virtual reality therapy uses immersive computer-generated environments that simulate real-life scenarios through visual and auditory channels for rehabilitation purposes.[19]

Table 3. Virtual reality research in complex injuries / conditions
Complex injury/condition Virtual Reality Research
Stroke
  • Virtual reality-based therapies are effective in improving executive function, memory and visual-spatial function in persons with stroke. However, further research is necessary for the effectiveness of virtual reality therapy on global cognitive function, attention, verbal fluency, depression and quality of life.[20]
  • Virtual reality induced changes in neural plasticity for persons with stroke, reflecting restoration and compensation of functional deficits.[21]
  • Virtual reality therapy can improve limb function, gait, balance, and daily function in persons with stroke.[22]
  • Read more: Virtual Reality for Individuals Affected by Stroke
Parkinson's
Burn injuries
  • Virtual reality-based burn rehabilitation can[24]:
    • improve quality of life
    • improve work performance
    • increase range of motion
    • reduce pain and the time spent thinking about pain
    • make rehabilitation more fun
    • reduce treatment-related anxiety
Traumatic brain injury
  • Virtual reality therapy shows promising results in improving aspects of cognitive function, such as memory and executive function, in persons with traumatic brain injury.[25]
  • Virtual reality is a safe and well-tolerated intervention in persons with traumatic brain injury. It may have a positive effect on balance and mobility in persons with TBI, but further research is needed. When combined with other rehabilitation interventions, balance and mobility can improve.[26]
Limb loss
  • Positive effects of virtual reality in persons with amputations include: improved balance and gait, and people reported a positive experience with the intervention. Further research is necessary.[27]
Spinal cord injuries
  • Virtual therapy in spinal cord injuries may be beneficial, with some evidence showing that it can improve motor function, motor skills, balance and aerobic function. Research is still limited in this area, and more robust and high-quality research is needed.[28] Another factor to consider is the cost involved in obtaining the necessary equipment and weighing that up against the perceived benefits.[29]

Benefits and Challenges of Virtual Reality Therapy[edit | edit source]

Table 4. Benefits and Challenges of Virtual Reality Therapy
Benefits Challenges
Effective in patient treatments (e.g. improved balance and gait)[30] Implementation of the system (e.g. high costs, technical limitations, and availability of suitable games for rehabilitation)[30]
Motor development (e.g. increased motor skills and mobility)[30] Applicability information is lacking - research on standardised methods to perform exercises, standardised times or application periods is still necessary[30] (i.e. evidence-based protocols)
Patient independence encouraged (e.g. increased quality of life, reduced anxiety)[30] Patient-related factors, such as follow-up period and drop-out rates[30]
Increased patient motivation Potential motion sickness[31]
Ability to adapt therapy sessions to individual needs

Wearable Technology[edit | edit source]

Wearable technology refers to devices worn on the body that can monitor, track or enhance different aspects of health and well-being. In focus group discussions with persons with stroke and physiotherapists on the potential benefits of wearable technology to support the motivation for home exercise, the following conclusions were drawn[32]:

  • The wearable technology should be flexible as patients and rehabilitation professionals have multi-faceted needs. These needs relate to[32]:
    • design of technology
    • user-friendliness
    • the way feedback is provided
    • the way use of this technology will support patient motivation and cooperation
  • A patient's use of wearable technology depends "as much on their trust in the professional and relational competence of the physiotherapist as the technical issues of an app".[32]

Wearable technology is generally used in the following contexts:

  • prediction of future events
  • detection of critical events
  • diagnostic monitoring to improve decision-making

In rehabilitation, some examples of wearable technology include[33]:

  • Advanced wearable sensors
    • accelerometers
    • inertial measurement units
    • body-worn sensors (e.g. chest-worn heart-monitoring straps, headbands for brain activity, posture-detecting monitors)
    • smart clothing (e.g. in hand rehabilitation, a smart glove and associated technology can be used to aid therapy)

Read more: Wearable technologies for active living and rehabilitation: Current research challenges and future opportunities. [33]

Table 5. Wearable technology research in complex injuries / conditions
Complex injury/condition Wearable technology research
Limb loss Functional mobility during everyday life can be measured with wearable technology in persons with lower limb amputations and information from this can be used to aid in prosthetic prescription or in the assessment of various interventions and treatments.[34]
Multiple orthopaedic trauma Wearable activity monitors, such as accelerometry and plantar force measurements can be used to measure specific outcomes, provide objective evidence for physical activity and help to personalise treatment plans in persons after orthopaedic trauma surgery.[35]
Stroke The use of wearable technology in persons with stroke can reduce bias in measurements and estimations. It can also reduce assessment time for rehabilitation professionals. Rehabilitation can be improved through home-based therapies being monitored and designed remotely, but allowing the patient to train in a safe and familiar environment.[36]
Ageing populations Wearable technology can be used for fall identification and prevention and disease management.[37]

Benefits and Challenges of Wearable Technology[edit | edit source]

Table 6. Benefits and challenges of wearable technology
Benefits Challenges
Continious monitoring Device accuracy
Early intervention Standardisation of methods and equipment
Personalised care Privacy and confidentiality of information
Need for user-friendly designs
Power consumption

Read more: Wearable technology applications in healthcare: a literature review.[37]

Robotics and Exoskeletons[edit | edit source]

Robotics and exoskeletons involve the use of mechanical devices that assist or augment human movement. Read more on Robotic Rehabilitation for the Lower Extremity and Upper Extremity Rehabilitation using Robotics.

Factors that affect the implementation of robotics and exoskeletons in clinical rehabilitation include[38]:

  • having sufficient knowledge of the characteristics of the device
  • proper training for rehabilitation professionals to use the technology
  • availability of resources
  • communication between members of the multidisciplinary team
  • patient expectations need to be managed, realistic and shared therapeutic goals are important

Artificial Intelligence and Machine Learning in Rehabilitation[edit | edit source]

Artificial intelligence (AI) refers to a collection of technologies (machine learning, natural language processing, rule-based expert systems, robotics) that analyse data and find patterns which facilitate decision-making, diagnosis, treatment recommendations and follow-up.[39]

Read more: The potential for artificial intelligence in healthcare[39]and The role of artificial intelligence in healthcare: a structured literature review[40]

Benefits and Challenges of AI[edit | edit source]

Table 7. Benefits and Challenges of artificial intelligence
Benefits Challenges
Improve patient care Ethical issues with data privacy
Streamline rehabilitation processes Impact of automation on the rehabilitation workforce
Drive innovation

Augmented Reality[edit | edit source]

Augmented reality involves the generation of new images from digital information in a person's real physical environment. It enhances a person's perception and interaction with their environment. It shows potential in areas of physical performance, balance and falls prevention treatment and improvement of pain in phantom pain syndrome, as well as lower and upper limb functionality in stroke. Further research regarding its efficacy is still needed.[41]

Table 8. Augmented reality research and complex injuries / conditions
Complex injury/condition Augmented Reality Research
Stroke Augmented reality shows promising results in the improvement of neuroplasticity and enhancing quality of life in persons with stroke when used with conventional therapy.[42]
Parkinson's Augmented reality provides a playful and integrative nature to rehabilitation, and similar results are seen with postural control in persons with Parkinson's as compared to neurofunctional physiotherapy.[43]

Outcome Measurements in Patients with Complex Injuries and Conditions[edit | edit source]

Resources[edit | edit source]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 Winstein C, Requejo P. Innovative technologies for rehabilitation and health promotion: what is the evidence?. Physical therapy. 2015 Mar 1;95(3):294-8.
  2. ↑ Giesbrecht E, Major ME, Fricke M, Wener P, van Egmond M, Aarden JJ, Brown CL, Pol M, van der Schaaf M. Telerehabilitation delivery in Canada and the Netherlands: results of a survey study. JMIR Rehabilitation and Assistive Technologies. 2023 Feb 20;10(1):e45448.
  3. ↑ Brennan D, Tindall L, Theodoros D, Brown J, Campbell M, Christiana D, Smith D, Cason J, Lee A. A blueprint for telerehabilitation guidelines. International journal of telerehabilitation. 2010;2(2):31.
  4. ↑ Laver KE, Adey‐Wakeling Z, Crotty M, Lannin NA, George S, Sherrington C. Telerehabilitation services for stroke. Cochrane Database of Systematic Reviews. 2020(1).
  5. ↑ Nikolaev VA, Nikolaev AA. Recent trends in telerehabilitation of stroke patients: A narrative review. NeuroRehabilitation. 2022 Jan 1;51(1):1-22.
  6. ↑ 6.0 6.1 6.2 Özden F, Özkeskin M, Ak SM. Physical exercise intervention via telerehabilitation in patients with neurological disorders: A narrative literature review. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2022 Feb 19;58(1):26.
  7. ↑ Di Tella S, Pagliari C, Blasi V, Mendozzi L, Rovaris M, Baglio F. Integrated telerehabilitation approach in multiple sclerosis: a systematic review and meta-analysis. Journal of telemedicine and telecare. 2020 Aug;26(7-8):385-99.
  8. ↑ Vellata C, Belli S, Balsamo F, Giordano A, Colombo R, Maggioni G. Effectiveness of telerehabilitation on motor impairments, non-motor symptoms and compliance in patients with Parkinson's disease: a systematic review. Frontiers in Neurology. 2021 Aug 26;12:627999.
  9. ↑ 9.0 9.1 9.2 Touchett H, Apodaca C, Siddiqui S, Huang D, Helmer DA, Lindsay JA, Ramaswamy P, Marchant-Miros K, Skelton F. Current approaches in telehealth and telerehabilitation for spinal cord injury (TeleSCI). Current Physical Medicine and Rehabilitation Reports. 2022 Jun;10(2):77-88.
  10. ↑ Bonanno M, De Luca R, De Nunzio AM, Quartarone A, Calabrò RS. Innovative technologies in the neurorehabilitation of traumatic brain injury: a systematic review. Brain sciences. 2022 Dec 7;12(12):1678.
  11. ↑ Subbarao BS, Stokke J, Martin SJ. Telerehabilitation in acquired brain injury. Physical Medicine and Rehabilitation Clinics. 2021 May 1;32(2):223-38.
  12. ↑ Aragaki D, Luo J, Weiner E, Zhang G, Darvish B. Cardiopulmonary telerehabilitation. Physical Medicine and Rehabilitation Clinics. 2021 May 1;32(2):263-76.
  13. ↑ Baroni MP, Jacob MF, Rios WR, Fandim JV, Fernandes LG, Chaves PI, Fioratti I, Saragiotto BT. The state of the art in telerehabilitation for musculoskeletal conditions. Archives of Physiotherapy. 2023 Jan 4;13(1):1.
  14. ↑ Cottrell MA, Galea OA, O’Leary SP, Hill AJ, Russell TG. Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis. Clinical rehabilitation. 2017 May;31(5):625-38.
  15. ↑ Plaza A, Paratz J, Cottrell M. A six-week physical therapy exercise program delivered via home-based telerehabilitation is comparable to in-person programs for patients with burn injuries: a randomized, controlled, non-inferiority clinical pilot trial. Burns. 2023 Feb 1;49(1):55-67.
  16. ↑ Van Egmond MA, Van Der Schaaf M, Vredeveld T, Vollenbroek-Hutten MM, van Berge Henegouwen MI, Klinkenbijl JH, Engelbert RH. Effectiveness of physiotherapy with telerehabilitation in surgical patients: a systematic review and meta-analysis. Physiotherapy. 2018 Sep 1;104(3):277-98.
  17. ↑ 17.0 17.1 17.2 17.3 Webster J, Young P, Kiecker J. Telerehabilitation for amputee care. Physical Medicine and Rehabilitation Clinics. 2021 May 1;32(2):253-62.
  18. ↑ 18.0 18.1 18.2 Scholten J, Poorman C, Culver L, Webster JB. Department of veterans affairs polytrauma telerehabilitation: twenty-first century care. Physical Medicine and Rehabilitation Clinics. 2019 Feb 1;30(1):207-15.
  19. ↑ Rutkowski S, Kiper P, Cacciante L, Mazurek J, Turolla A. Use of virtual reality-based training in different fields of rehabilitation: A systematic review and meta-analysis. Journal of Rehabilitation Medicine. 2020 Nov 19;52(11):1-6.
  20. ↑ Zhang Q, Fu Y, Lu Y, Zhang Y, Huang Q, Yang Y, Zhang K, Li M. Impact of virtual reality-based therapies on cognition and mental health of stroke patients: systematic review and meta-analysis. Journal of medical Internet research. 2021 Nov 17;23(11):e31007.
  21. ↑ Hao J, Xie H, Harp K, Chen Z, Siu KC. Effects of virtual reality intervention on neural plasticity in stroke rehabilitation: a systematic review. Archives of Physical Medicine and Rehabilitation. 2022 Mar 1;103(3):523-41.
  22. ↑ Zhang B, Li D, Liu Y, Wang J, Xiao Q. Virtual reality for limb motor function, balance, gait, cognition and daily function of stroke patients: A systematic review and meta‐analysis. Journal of advanced nursing. 2021 Aug;77(8):3255-73.
  23. ↑ Sevcenko K, Lindgren I. The effects of virtual reality training in stroke and Parkinson’s disease rehabilitation: a systematic review and a perspective on usability. European Review of Aging and Physical Activity. 2022 Dec;19(1):4.
  24. ↑ Lan X, Tan Z, Zhou T, Huang Z, Huang Z, Wang C, Chen Z, Ma Y, Kang T, Gu Y, Wang D. The use of virtual reality in burn rehabilitation: A systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation. 2022 Aug 27.
  25. ↑ Alashram AR, Annino G, Padua E, Romagnoli C, Mercuri NB. Cognitive rehabilitation post traumatic brain injury: A systematic review for emerging use of virtual reality technology. Journal of Clinical Neuroscience. 2019 Aug 1;66:209-19.
  26. ↑ Alashram AR, Padua E, Annino G. Virtual reality for balance and mobility rehabilitation following traumatic brain injury: A systematic review of randomized controlled trials. Journal of clinical neuroscience. 2022 Nov 1;105:115-21.
  27. ↑ Hao J, Chen Z, Remis A, He Z. Virtual Reality–Based Rehabilitation to Restore Motor Function in People With Amputation: A Systematic Literature Review. American Journal of Physical Medicine & Rehabilitation. 2023 May 1;102(5):468-74.
  28. ↑ de Araujo AV, Neiva JF, Monteiro CB, Magalhães FH. Efficacy of virtual reality rehabilitation after spinal cord injury: a systematic review. BioMed research international. 2019 Nov 13;2019.
  29. ↑ Ionite C, Rotariu M, Turnea M, Ilea M, Condurache I. A Review about the Effectiveness of Virtual Therapy in the Recovery of Patients with Spinal Cord Injuries. Journal of Men's Health. 2022 Jul 19;18(8):160.
  30. ↑ 30.0 30.1 30.2 30.3 30.4 30.5 Brepohl PC, Leite H. Virtual reality applied to physiotherapy: a review of current knowledge. Virtual Reality. 2023 Mar;27(1):71-95.
  31. ↑ Howard MC, Van Zandt EC. A meta-analysis of the virtual reality problem: Unequal effects of virtual reality sickness across individual differences. Virtual Reality. 2021 Dec;25(4):1221-46.
  32. ↑ 32.0 32.1 32.2 Stock R, Gaarden AP, Langørgen E. The potential of wearable technology to support stroke survivors’ motivation for home exercise–Focus group discussions with stroke survivors and physiotherapists. Physiotherapy Theory and Practice. 2023 May 27:1-2.
  33. ↑ 33.0 33.1 Rodgers MM, Alon G, Pai VM, Conroy RS. Wearable technologies for active living and rehabilitation: Current research challenges and future opportunities. Journal of rehabilitation and assistive technologies engineering. 2019 Apr;6:2055668319839607.
  34. ↑ Kim J, Colabianchi N, Wensman J, Gates DH. Wearable sensors quantify mobility in people with lower limb amputation during daily life. IEEE Transactions on Neural Systems and Rehabilitation Engineering. 2020 Apr 28;28(6):1282-91.
  35. ↑ Marmor MT, Grimm B, Hanflik AM, Richter PH, Sivananthan S, Yarboro SR, Braun BJ. Use of Wearable Technology to Measure Activity in Orthopaedic Trauma Patients: A Systematic Review. Indian Journal of Orthopaedics. 2022 Jul;56(7):1112-22.
  36. ↑ Maceira-Elvira P, Popa T, Schmid AC, Hummel FC. Wearable technology in stroke rehabilitation: towards improved diagnosis and treatment of upper-limb motor impairment. Journal of neuroengineering and rehabilitation. 2019 Dec;16(1):1-8.
  37. ↑ 37.0 37.1 Wu M, Luo J. Wearable technology applications in healthcare: a literature review. Online J. Nurs. Inform. 2019 Nov;23(3).
  38. ↑ Charette C, Déry J, Blanchette AK, Faure C, Routhier F, Bouyer LJ, Lamontagne ME. A Systematic Review of the Determinants of Implementation of a Locomotor Training Program Using a Powered Exoskeleton for Individuals with a Spinal Cord Injury. Clinical Rehabilitation. 2023 Apr 10:02692155231164092.
  39. ↑ 39.0 39.1 Davenport T, Kalakota R. The potential for artificial intelligence in healthcare. Future healthcare journal. 2019 Jun;6(2):94.
  40. ↑ Secinaro S, Calandra D, Secinaro A, Muthurangu V, Biancone P. The role of artificial intelligence in healthcare: a structured literature review. BMC medical informatics and decision making. 2021 Dec;21:1-23.
  41. ↑ Gil MJ, Gonzalez-Medina G, Lucena-Anton D, Perez-Cabezas V, Ruiz-Molinero MD, Martín-Valero R. Augmented reality in physical therapy: systematic review and meta-analysis. JMIR Serious Games. 2021 Dec 15;9(4):e30985.
  42. ↑ Khokale R, Mathew GS, Ahmed S, Maheen S, Fawad M, Bandaru P, Zerin A, Nazir Z, Khawaja I, Sharif I, Abdin ZU. Virtual and Augmented Reality in Post-stroke Rehabilitation: A Narrative Review. Cureus. 2023 Apr 14;15(4).
  43. ↑ Araujo HA, Souza RJ, da Silva TC, Nascimento TS, Terra MB, Smaili SM. Immediate Effect of Augmented Reality, Virtual Reality, and Neurofunctional Physiotherapy on Postural Control and Executive Function of Individuals with Parkinson's Disease. Games for Health Journal. 2023 Jun 1;12(3):211-9.
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