TeleExergame: An Interactive Tele-Rehabilitation Platform for Improving Motor Function in Older Adults with Cognitive Deficit

摘要 许多患有轻度认知障碍(MCI)和/或轻度痴呆的人都有这两种认知缺陷 运动功能和姿势平衡能力下降。这会增加摔倒的风险。常规天平 这些计划并不是为认知障碍患者量身定做的。开发的运动认知练习 对于这些患者来说可能是有效的，但这些康复计划没有得到充分利用。许多患者是 推荐的锻炼计划从来不参加；更少的是完整的规定计划。适用于认知障碍患者 损害、运输和调度是限制他们坚持和 承诺。然而，无人监督的家庭锻炼计划对这些人来说是不够的，因为 缺乏坚持性、冷漠和不能遵循运动指令。因此，需要一种远程- 为患有MCI和/或轻度痴呆症的老年人提供监督的居家锻炼计划。 为了解决这一需求，我们建议开发一种远程锻炼系统，允许合格的治疗师远程 在目标导向、类似游戏和低风险的锻炼任务中监督和与患者互动 (TeleExerGame)，旨在改善平衡和认知。这些练习是互动的 平衡任务与明确的目标导向的增强视觉反馈(即，患者的运动控制 屏幕上的虚拟对象，从而提供对参与至关重要的实时视觉和音频反馈 和运动学习)。这是通过佩戴在感兴趣的身体部分(例如，小腿)上的可穿戴传感器来实现的，该传感器 测量身体关节运动学(例如，在虚拟越障任务中脚/脚踝的位置)。 对于这份快速提交的报告，我们对22名遗忘型MCI患者进行了初步研究， 这证明了所提出的游戏训练模式在目标人群中的有效性。在……里面 第一阶段，我们将创建第一个简单易用的家庭游戏解决方案的原型，其中包括 远程医疗界面，帮助患者或其照顾者进行传感器定位、运行程序、 远程监控，并在锻炼期间对患者进行监控。我们将评估以下项目的可行性、观感 在治疗师的目标人群和焦点群体中，建议的系统的益处和易用性。同相 II，我们将完成TeleExerGame系统的开发，以实现HIPAA兼容的远程监控 由合格的治疗师提供，并为远程监控和个性化练习提供量化指标 由治疗师提供的程序。然后，我们将进行一项临床研究，以评估该溶液的疗效。 拟议的交互式远程康复系统将对患者产生立竿见影的影响 通过为MCI和/或轻度痴呆症患者提供互动锻炼计划进行护理。然而，MCI 痴呆症只占拟议技术潜在市场的一小部分，这也可能是 用于其他平衡能力较差的患者群体，如帕金森氏症、糖尿病、中风 患有下肢瘫痪的幸存者，以及不能进行常规锻炼的老年人。

ABSTRACT Many individuals with mild cognitive impairment (MCI) and/or mild dementia experience both cognitive deficits and decline in motor function and postural balance. This results in an increased risk of falls. Conventional balance programs are not tailored for patients with cognitive impairment. Motor-cognitive exercises that are developed for these patients can be effective, but these rehabilitation programs are underutilized. Many patients who were referred exercise programs never attend; even fewer complete prescribed programs. For patients with cognitive impairment, transportation and scheduling are some of the key challenges that limit their adherence and commitment. However, unsupervised in-home exercise programs are not adequate for these individuals because of poor adherence, apathy, and inability to follow exercise instructions. Therefore, there is a need for a remotely- supervised in-home exercise program for older adults with MCI and/or mild dementia. To address this need, we propose to develop a tele-exercise system that allows a qualified therapist to remotely supervise and interact with the patient during goal-oriented game-like and low risk exercise tasks (TeleExergame) that have been designed to improve balance and cognition. The exercises are interactive balance tasks with explicit goal-oriented augmented visual feedback (i.e., the patient’s movement controls a virtual object on the screen, thus providing real-time visual and audio feedback that is critical for engagement and motor learning). This is achieved by a wearable sensor worn on a body segment of interest (e.g., shin) that measures body joint kinematics (e.g., position of foot/ankle during a virtual obstacle crossing task). For this Fast-Track submission, we conducted a preliminary study in a cohort of 22 patients with amnestic MCI, which demonstrated the effectiveness of the proposed Exergame training paradigm in the target population. In Phase I, we will create the first prototype of an easy-to-use Exergame solution for in-home use that includes a telemedicine interface to assist the patient or his/her caregiver with sensor positioning, running the program, remote supervision, and monitoring of the patients during exercise. We will evaluate the feasibility, perception of benefit, and ease of use of the proposed system in the target population and focus group of therapists. In Phase II, we will complete the development of the TeleExergame system to enable HIPAA compliant remote supervision by a qualified therapist and provide quantitative metrics for remote monitoring and personalization of the exercise program by the therapist. We will then conduct a clinical study to evaluate the efficacy of the solution. The proposed interactive tele-rehabilitation system would have an immediate and appreciable impact on patient care by providing an interactive exercise program for individuals with MCI and/or mild dementia. However, MCI and dementia represent only a fraction of the potential market for the proposed technology, which could also be used in other patient populations that exhibit poor balance, such as Parkinson’s disease, diabetics, stroke survivors with lower-extremity paresis, and older adults who cannot perform conventional exercises.