Glenrose Rehabilitation Hospital
Technology Strategy
Building on our strengths through technology…
Advanced technology in rehabilitation is exploding as new and innovative approaches to therapy emerge and build on the talents and ingenuity of rehabilitation staff. Computers,wireless and internet communications, compact and inexpensive sensors, robotics, nanotechnology, and the seamless integration of these technologies are no longer restricted to exceptional devices – they are found in everyday life.
Rehabilitation technology combines clinical expertise and rehabilitation engineering to build devices and processes that improve the lives of people who experience some form of a disability. Family members and caregivers are also benefactors from the use of technology.
Success in applying science, research and technology has put the Glenrose at the forefront in rehabilitation advances. To remain on the leading edge we will fully participate in the opportunities that rehabilitation technology offers.
For Albertans to get the most benefit from these advances, a focused and explicit effort is required to identify, assess and implement rapidly emerging technologies. This Technology Strategic Plan has been prepared to describe the major directions in which technology will play a role in enhancing rehabilitation at the Glenrose and beyond.
How can technology help …
Many people of all ages must cope with some form of disability as a consequence of accident, aging, disease, or heredity.
Regardless of the impairment, people strive to be independent and actively involved with their families and their communities. This involvement can be limited by cognitive, physical, sensory, or communication impairments. Technology can help patients and families to optimize their abilities to participate in life.
Supporting thinking, reasoning and analyzing
Decline in mental function is due to many factors and can affect memory, attention, and higher brain level functions such as problem solving. The result is reduced independence, safety and social involvement.Wristwatches, cell phones and electronic organizers have built-in task rembuilt-inders and schedule planners - more advanced versions use intelligence to detect medical problems and make action decisions. Reminding someone when to take medication is also an important function.
Smart tags contain prescription information on microchips for those with difficulty reading or understanding medication instructions. Radio frequency identification (RFID) linked to a reader enables the prescription information to be “spoken”. Watches and pagers that include a global positioning (GPS) locator, emergency caller, pulse monitor and fall detection features can help those with such cognitive problems as disorientation and wandering. In buildings where GPS is unavailable, wireless sensor devices can be used by caregivers of cognitively-impaired individuals to prevent night time injuries and unattended exits.
Rehabilitation exercises can improve perception, memory, and judgment by presenting challenging tasks to help restore lost function or prevent mental decline due to aging. Specially designed software programs offer the possibility of “brain
Supporting active involvement in society
Immersive simulations incorporate the movements and physical actions of the individual into a 3-D computer model of a social environment. One of the most exciting possibilities for
innovation in this area is the potential for self-directed discovery for children through exploration of virtual worlds.
For many people, driving is essential to independence and social connectedness. However, mental and physical changes (slowed reaction time, decreased coordination and concentration) negatively affect driving abilities.
Advanced driving simulators can provide challenging but controlled environments to improve assessments and measure driver response to distractions and changing conditions. Driving simulators also offer a safe training environment.
For people who cannot easily get out, online support groups and virtual communities help people connect and share with others. Optimizing an individual’s cognitive function in such areas as memory and problem solving can provide more independence in daily functioning, assist in their social interactions, and maintain or enhance quality of life. Personalized approaches are available for individuals and their families. Depending upon area of need, these may include acquiring new mental strategies, effectively using electronic and non-electronic devices, and stimulating the efficient use of existing cognitive functions.
Improving the ability to walk and move about
freely
People who have physical disabilities and those who are older often experience mobility issues that result in limitations with regard to walking, stair climbing or personal care.
Technologies to enhance walking or mobility include: • Advanced wheelchairs that use dynamic balancing
systems to enable travel over uneven surfaces and stairs, navigation and obstacle detection/avoidance systems and controllable seat positioning that improves ability to perform many of life’s daily tasks, and can even enable a person to stand upright.
• Intelligent walkers that are augmented with cueing systems that alert users to danger zones, prompt them with navigational instructions or provide assistance with sit-to-stand manoeuvres.
• Canes with sensors producing sounds or a vibration to warn the user of an obstruction.
• Smarter lifting and transfer devices ease the tasks of staff or caregivers.
Improving the ability to walk and move about
freely
Prostheses are typically used to replace body parts lost by injury or missing from birth and orthoses supplement an impaired limb. Technologies helping these people are:
• Prostheses that are controlled by thinking – resulting in more natural limb movement
• Microprocessor-controlled joints to improve stability and reliability on a variety of terrain and significantly
increase the amputee’s sense of safety.
• Digital scanning and alignment of the limb using computer models to determine optimal force
transmission is improving the fitting of limb sockets. • Smart orthotics with sensors and actuators that are
capable of augmenting lost muscle functions or providing complete external support.
Movement recovery through enhanced therapy
Recent neuroscience evidence strongly supports intensive therapy to improve movement recovery for impairments ranging from spinal cord injury, brain injury, and stroke. This“retraining” requires intense, repeated exposure to goal-oriented tasks.
Robotic rehabilitation devices can deliver treatments in highly repetitive dosages with minimal physical exertion by the therapist while optimizing involvement of the patient. Robotic systems available to enhance traditional gait therapy can support the patient’s body weight and assist with walking motions – supplying therapy intensity and duration that is impracticable to obtain by manual means.
Upper limb impairments involving the shoulder and elbow affect the reaching and grasping, functions important to everyday activities of daily living. Robotic arms with sensors can “assist as necessary” during therapy, recording progress and providing target motions.
Hand and wrist function is a complex interplay between gross and fine motor control and recovering this function improves most daily activities. Technologies to encourage and measure rehabilitative movements include interactive screens and tabletops, force sensing gloves, and haptic devices – those that incorporate the sense of touch.
Movement recovery through enhanced therapy
Virtual reality is well suited to movement and balance therapies and also to strength conditioning exercises by providing tasks of graded difficulty in motivating scenes. The “game like” aspect can relieve boredom and encourage intensive therapy.Many of the therapies can be internet-based, offering
opportunities after discharge to continue supervised therapy in the patient’s community. Enabling therapy to continue via telerehabilitation is attractive to many patients who are keen to return to familiar surroundings and makes economic sense for the hospital.
Computerized balance assessment outcomes are important when designing therapeutic balance programs. Immersive
environments assess and train patients in a variety of controlled sensory and support surface conditions. Sensors can provide a substitute for missing sensory information.
Overcoming sensory impairments
Augmentative and alternative communication devices assist
people with severe communication disabilities to participate more fully in social interactions – increasing independence and quality of life. These devices hold the promise of enabling those with severe dysfunctions to become engaged members of their communities.
Advances in technologies are improving the ease of use and quality of synthetic speech and direct brain–computer interfaces are showing promising results.
Significant advancements for the people with a hearing impairment are being made in both assessment and in devices to improve hearing.
Brain wave measurement allows the hearing of newborn infants to be assessed, which means hearing aid devices can be fitted at a very early age. This greatly enhances the speech and language potential for these children.
Cochlear implant technology helps many people with very severe hearing impairments. These surgically-implanted devices use individually-programmed external speech processors to deliver sound directly to the inner ear.
Overcoming sensory impairments
Innovative technology for persons with visual impairments includes electronic reading devices and mobility assistance. Scanners with optical character recognition systems enable text to be read aloud using synthetic speech.
Synthesized speech output and Braille docking stations are available for communication input and output on selected cell phones.
Innovative applications of vocalized GPS systems can also help those with visual impairments to be mobile within their
communities
Treating a person in pain presents significant challenges to health care providers.
Soothing immersive environments have been shown to help by distracting patients, enabling them to better tolerate pain and to persevere with beneficial therapies.
Benefits to Albertans
The planned introduction and rigorous evaluation of innovative technology for rehabilitation supports Capital Health’s strategy to “promote better health outcomes through the development of technology-based health solutions” and will lead to better outcomes for Albertans.
With more effective and cost-efficient procedures, technologies and “smarter” living and working environments, we will reduce the functional impact of physical and cognitive impairments associated with an accident, aging, disease, or heredity. Although the clinical usefulness of many of the innovations being developed in the laboratory may seem a distant promise, there are immediate opportunities for:
• Robotics,
• Virtual rehabilitation, • Cognitive rehabilitation, and • Telerehabilitation.
Each technology can stand-alone but effectiveness is enhanced when used in combination with each other. All can provide quantifiable results to assist the therapist with setting goals, marking progress and evaluating treatment outcomes.
Benefits to Albertans
Robotics can support key elements of intense repetitive, quantifiable rehabilitation programs by repeatedly guiding or assisting patients through natural limb movements. When combined with virtual rehabilitation tools, innovative robotic systems can motivate patients to persist with therapy. With development, robotic systems can extend institutional-based therapies into the community.
Virtual rehabilitation adds therapeutic, motivational elements within a realistic, controllable environment. Applications are in progress for a wide variety of impairments: to assist with
recovery of body movements, as aids to cognition and to support social inclusion. Innovative immersive technologies
incrementally introduce the complexities of the real world in a safe and controlled manner. Most of all, virtual rehabilitation adds a sense of fun to therapy.
Cognitive function can be optimized in such areas as memory and problem solving and can provide an individual with more independence in daily functioning, assist in their social interactions, and maintain or enhance quality of life.
Impairments can result from brain injury, stroke or dementia. Existing methods of minimizing such losses range from simple reminder systems to the use of sophisticated computer software. Telerehabilitation allows people with a range of needs to retain their independence and continue therapy after discharge.
Intelligent design of living accommodations supports individuals through activities of daily living, monitors their health and safety, assists with social connectedness and alerts health care workers to the need for possible intervention.
Delivering change
Introducing significant technology for rehabilitation requires the involvement and commitment of all levels of the organization. This is especially true for proposed “innovations” because the promise of improvement may not be fulfilled due to a lack of performance guidelines, a lack of techniques to quantify most interventions, robotic or manual, and an inability to relate interventions to outcomes – all of which make it difficult to measure effectiveness.
It is only through clinical application that effectiveness and utility of proposed innovative technology can be proven.
Ultimate acceptance of rehabilitation technology depends on its ability to deliver functional benefits in a patient-friendly
manner.
Change is most effective when all stakeholders can contribute; when it is based on actual results and when staff are supported through the journey from initial testing to successful
incorporation into clinical practice. This requires explicit processes built around strong communication and resources linked to a strategic vision and a plan of action.
The Rehabilitation Technology Strategy
The following strategies are proposed to accomplish the vision and achieve the mission for successful rehabilitation technology at the Glenrose.
Separate documents provide the details of the three main strategies.
Build the Team
• Engineers and clinicians with the oversight of local and international committees
GRH Financial Implementation Plan rehab technology.doc GRH Local Tech Steering Committee Terms of Ref.doc GRH Intl Tech Steering Committee Terms of Ref.doc
Develop a Strong Communication Plan
• Input and feedback from all stakeholders is vital to the success of technology strategy
GRH Communication plan.doc
Develop a Process for the Introduction of New Technology • Current needs and emerging technologies
