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/或轻度痴呆的个体经历两种认知缺陷 以及运动功能和姿势平衡的下降。这导致福尔斯的风险增加。常规平衡 这些项目并不是为认知障碍患者量身定制的。运动认知练习是由 对这些病人来说是有效的，但这些康复计划没有得到充分利用。许多患者 推荐的锻炼计划从不参加;完成规定的计划的人更少。对于认知障碍患者 损伤、运输和调度是限制其遵守的一些关键挑战， 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 坚持性差，冷漠，无法遵循锻炼指导。因此，需要远程- 为患有MCI和/或轻度痴呆的老年人提供有监督的家庭锻炼计划。 为了满足这一需求，我们建议开发一种远程锻炼系统，允许合格的治疗师远程 在以目标为导向的游戏式和低风险的锻炼任务中监督患者并与患者互动 （远程游戏），旨在提高平衡和认知能力。练习是互动的 平衡任务与明确的面向目标的增强视觉反馈（即，病人的运动控制着 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 运动学习）。这是通过佩戴在感兴趣的身体部分（例如，shin）， 测量身体关节运动学（例如，在虚拟障碍物穿越任务期间的脚/踝的位置）。 对于这项快速通道提交，我们在22名遗忘型MCI患者的队列中进行了初步研究， 这证明了在目标人群中所提出的游戏训练范例的有效性。在 在第一阶段，我们将创建第一个易于使用的家庭游戏解决方案的原型，其中包括 远程医疗接口，以帮助患者或他/她的护理人员进行传感器定位，运行程序， 远程监控，以及在运动过程中对患者的监控。我们将评估可行性，感知， 在目标人群和治疗师的焦点小组中，所提出的系统的益处和易用性。同相 二、完成Telephone游戏系统的开发，实现符合HIPAA的远程监管 并为远程监控和个性化锻炼提供定量指标 治疗师的节目。然后，我们将进行临床研究，以评估该解决方案的有效性。 拟议的互动式远程康复系统将对病人产生直接和明显的影响， 通过为MCI和/或轻度痴呆患者提供互动式锻炼计划来护理。然而，MCI 和痴呆症只代表了拟议技术潜在市场的一小部分， 用于其他表现出平衡不良的患者人群，如帕金森病、糖尿病、中风 下肢轻瘫幸存者和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.