Supporting Home-Based Stroke Care with Hybrid Self-Directed and Supervised Tele-Rehabilitation

在英国，每年有超过10万人受到中风的影响，导致长期残疾和依赖。预计新型冠状病毒疫情将进一步加剧这一医疗挑战，在危机期间以及随后放宽社交隔离限制的时期，对医疗资源造成重大额外压力。由于担心感染，许多新的中风病例现在不愿意接受急诊治疗，导致中风预后更差。相反，住院的中风患者目前面临住院时间缩短，康复缩短，因为需要优先为重症患者提供床位和治疗师;并防止中风住院患者因并发症的高风险而感染。因此，标准的住院患者康复：当前的护理标准，既更难获得资源，也更危险。GripAble由便携式手持设备和交互式软件组成，可为残疾人提供自我指导的手臂治疗。由于手臂残疾是中风引起的最常见的障碍（影响~70%）;手臂锻炼占住院患者物理治疗疗程的约50%，GripAble可以提供一种具有成本效益的、基于家庭的治疗替代品，以代替住院治疗时间的很大一部分。现在需要更广泛的康复护理包，以覆盖中风患者的多种生理和心理需求，这可以促进早期支持放电。这可以通过将GripAble提供的自我指导治疗与远程监督治疗（通过视频流）相结合来实现。这种“混合远程康复”将为家庭治疗提供比传统远程康复（即仅视频）更多的机会。在英国创新公司的支持下，将提供一个为期6个月的工作方案，以开发和试用一个综合的家庭治疗包，该包将GripAble（允许独立的手臂练习）与经批准的视频咨询软件（允许专家在必要时监督患者）相结合。这种组合包将使各种残疾中风患者能够比目前更早地出院;并且比单独的视频咨询更有效，后者缺乏互动运动游戏或个性化反馈等功能。

Over 100,000 people are affected by stroke in the UK annually, resulting in long-term disability /and dependency. The Covid-19 pandemic is expected to compound this healthcare challenge even further, placing significant additional strain on healthcare resource both during the crisis and in the period that follows as social-isolation restrictions are relaxed. Many new stroke cases are now reluctant to access emergency-care because of fear of infection, resulting in worse stroke outcomes. Conversely, hospitalized stroke patients are currently facing reduced length-of-stay, with rehabilitation curtailed, due to the need to prioritise beds and therapists for critically-ill patients; and to prevent stroke inpatients catching infection given their high risk of complications. As a result, standard in-patient rehabilitation: the current standard of care, is both more difficult to resource and more dangerous to deliver.GripAble comprises of a portable handheld device and interactive software enabling self-directed arm therapy in disabled people. Since arm disability is the commonest impediment caused by stroke (affecting ~70%); and arm- exercises account for ~50% of in-patient physiotherapy sessions, GripAble can provide a cost-effective, home-based therapy substitute in place of a significant fraction of in-hospital therapy time.A broader package of rehabilitation care is now required, to cover multiple physical and psychological needs of stroke patients, which can facilitate early supported discharge. This can be achieved by combining self-directed therapy offered by GripAble, with remote supervised therapy, (via video-streaming). This 'hybrid telerehabilitation' will offer significantly greater opportunities for home-therapy than conventional telerehabilitation (i.e. video alone).With Innovate UK support, a 6-month programme of work will be delivered to develop, and trial, a holistic, home-therapy package that combines GripAble (allowing independent arm exercises); with an approved video-consultation software (allowing specialists to supervise patients where necessary). This combination package will allow a wide range of disabled stroke patients to be discharged from hospital earlier than is currently achieved; and be more effective than video-consultations alone, that lacks features such as interactive-exercise games, or personalised feedback.