Article

Although motor learning theory has led to evidence-based practices, few trials
have revealed the superiority of one theory-based therapy over another after
stroke. Nor have improvements in skills been as clinically robust as one might
hope. We review some possible explanations, then potential technology-enabled
solutions. Over the Internet, the type, quantity, and quality of practice and
exercise in the home and community can be monitored remotely and feedback
provided to optimize training frequency, intensity, and progression at home. A
theory-driven foundation of synergistic interventions for walking, reaching and
grasping, strengthening, and fitness could be provided by a bundle of home-based
Rehabilitation Internet-of-Things (RIoT) devices. A RIoT might include wearable,
activity-recognition sensors and instrumented rehabilitation devices with radio
transmission to a smartphone or tablet to continuously measure repetitions,
speed, accuracy, forces, and temporal spatial features of movement. Using
telerehabilitation resources, a therapist would interpret the data and provide
behavioral training for self-management via goal setting and instruction to
increase compliance and long-term carryover. On top of this user-friendly, safe,
and conceptually sound foundation to support more opportunity for practice,
experimental interventions could be tested or additions and replacements made,
perhaps drawing from virtual reality and gaming programs or robots. RIoT devices
continuously measure the actual amount of quality practice; improvements and
plateaus over time in strength, fitness, and skills; and activity and participation in home and community settings. Investigators may gain more control
over some of the confounders of their trials and patients will have access to inexpensive therapies.

Langue : ANGLAIS