A Clinical Perspective on Bespoke Sensing Mechanisms for Remote Monitoring and Rehabilitation of Neurological Diseases: Scoping Review

Abstract

Neurological diseases including stroke and neurodegenerative disorders cause a hefty burden on the healthcare system. Survivors experience significant impairment in mobility and daily activities, which requires extensive rehabilitative interventions to assist them to regain lost skills and restore independence. The advent of remote rehabilitation architecture and enabling technology mandates the elaboration of sensing mechanisms tailored to individual clinical needs. This study aims to review current trends in the application of sensing mechanisms in remote monitoring and rehabilitation in neurological diseases, and to provide clinical insights to develop bespoke sensing mechanisms. A systematic search was performed using the PubMED database to identify 16 papers published for the period between 2018 to 2022. Teleceptive sensors (56%) were utilized more often than wearable proximate sensors (50%). The most commonly used modality was infrared (38%) and acceleration force (38%), followed by RGB color, EMG, light and temperature, and radio signal. The strategy adopted to improve the sensing mechanism included a multimodal sensor, the application of multiple sensors, sensor fusion, and machine learning. Most of the stroke studies utilized biofeedback control systems (78%) while the majority of studies for neurodegenerative disorders used sensors for remote monitoring (57%). Functional assessment tools that the sensing mechanism may emulate to produce clinically valid information were proposed and factors affecting user adoption were described. Lastly, the limitations and directions for further development were discussed.

Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice on telerehabilitation. The European PRM position (UEMS PRM Section)

“…EMG-enhanced motion analysis and wearable technologies including various types of sensors (force-based or speed-based or teleceptive sensors), intelligent robots, and augmented reality-based telerehabilitation systems with haptics can be helpful in remote assessment. 26 - 29 In addition, artificial intelligence as exemplified in the evaluation of swallowing sound in patients with amyotrophic lateral sclerosis in a study, 30 can be used for remote assessment. 31 Increasing research deals with the feasibility and validity of assessment methods and the specific tools used for assessment in diverse health conditions.…”

“…5. It is recommended PRM physicians get familiar with the use and safety of physical sensors for tele-physical assessment including augmented reality-based systems with haptics and others and biometric sensors such as electromyography and other sensors, both wearable and/or noncontact, for diagnostic purposes when delivering telerehabilitation [SoE: IV; 26 - 29 SoR: A].…”

“…It is recommended that PRM physicians rely on the “Individual Rehabilitation Project” also for telerehabilitation as a framework for rehabilitation 17 where ICF is the reference system for operationalizing functioning as a basis for assessment within the context of telerehabilitation. Digital technologies can facilitate functional assessment with the use of teleconsultation, video-based consultations-online patient visit including looking at and listening to the patients’ complaints, video-based consultations including validated remote assessment/examination, video-based consultations including detailed assessment using tele-biometrics such as diagnostic tele-ultrasonography, telemonitoring, and wearable devices, prioritizing that the remote assessment is valid and reliable [SoE: IV; 11 - 13 , 20 - 29 , 34 , 50 SoR: A].…”

“…9. It is recommended, if the patient agrees, that PRM physicians use different advanced technologies including robotic systems that make precise, cost-effective, and repeatable measurements 26 , 28 , 29 as well as artificial intelligence 30 , 31 for functional assessment [SoE: IV; 26 - 31 SoR: B].…”

Assessment of Patient Treatment and Rehabilitation Processes Using Electromyography Signals and Selected Industry 4.0 Solutions

“…Improving the effectiveness and efficiency of treatment and rehabilitation processes will benefit both individuals and society as a whole. Today, various medical institutions recommend the management of treatment and rehabilitation processes [ 3 , 4 , 5 ]. Initial system recommendations for the re-engineering of treatment and rehabilitation processes are identified in the Recommendations for strengthening rehabilitation in health systems [ 1 ].…”