Single Camera-Based Remote Physical Therapy: Verification on a Large Video Dataset

In recent years, several systems have been developed to capture human motion in real-time using common RGB cameras. This approach has great potential to become widespread among the general public as it allows the remote evaluation of exercise at no additional cost. The concept of using these systems in rehabilitation in the home environment has been discussed, but no work has addressed the practical problem of detecting basic body parts under different sensing conditions on a large scale. In this study, we evaluate the ability of the OpenPose pose estimation algorithm to perform keypoint detection of anatomical landmarks under different conditions. We infer the quality of detection based on the keypoint confidence values reported by the OpenPose. We used more than two thousand unique exercises for the evaluation. We focus on the influence of the camera view and the influence of the position of the trainees, which are essential in terms of the use for home exercise. Our results show that the position of the trainee has the greatest effect, in the following increasing order of suitability across all camera views: lying position, position on the knees, sitting position, and standing position. On the other hand, the effect of the camera view was only marginal, showing that the side view is having slightly worse results. The results might also indicate that the quality of detection of lower body joints is lower across all conditions than the quality of detection of upper body joints. In this practical overview, we present the possibilities and limitations of current camera-based systems in telerehabilitation.

Acute giardiasis and Chapman reflexes: Musculoskeletal symptoms preceding, during and after infection

Giardiasis is an acute infection caused by Giardia lamblia, which produces profuse secretory diarrhea that can lead to dehydration and electrolyte derangement. Musculoskeletal manifestations resulting because of giardiasis occur due to prolonged inflammation and viscero-somatic reflexes of the pathophysiology for this disease process. By treating the parasitic infection with an antiparasitic agent, as well as treating the somatic dysfunctions with osteopathic manipulative treatment, analgesics and a home exercise program, the patient in the following article experienced an uneventful course of treatment and a complete recovery including resolution of the pain.

Interactive Computer Play in the Pursuit of Gait Optimization for Children With Cerebral Palsy

Exercise therapy delivered through interactive computer play (ICP) has been shown to be effective for improving gross motor skills, and ultimately gait, in children with cerebral palsy (CP). This chapter provides an overview of CP, its impact on, gait and the current physical therapy (PT) standard of care. The history of the home exercise program (HEP) component of standard PT care is described, along with the potential for using ICP to improve HEP. ICP systems are surveyed, and their defining features discussed. The current therapeutic use of ICP is described and directions for further development to enhance therapeutic utility presented. A theoretical framework to support ICP implementation, self-determination theory (SDT), is outlined, and an example of its exploration in a pilot effort is provided. An example of healthcare system barriers to rapid uptake of ICP is presented along with alternative strategies for deployment and recommendations for further research.

Feasibility of an individualised, task-oriented, video-supported home exercise programme for arm function in patients in the subacute phase after stroke: protocol of a randomised controlled pilot study

IntroductionStroke rehabilitation guidelines suggest a high-frequency task-oriented training at high intensity. A targeted and self-paced daily training with intermittent supervision is recommended to improve patients’ self-management and functional output. So far, there is conflicting evidence concerning the most effective home-training delivery method.Methods and analysisThe purpose of this pilot study is to compare the feasibility and preliminary effects of task-oriented home-exercises in patients in the subacute stage after stroke. Twenty-four patients will be randomised (1:1) to a Video group (a) or Paper group (b) of an individualised, task-oriented home-training (50 min, 6×/week, for 4 weeks) based on Wulf and Lewthwaite’s Optimizing Performance Through Intrinsic Motivation and Attention for Learning theory of motor learning. Patient-relevant goals will be identified using Goal Attainment Scaling and exercises progressively adapted. Semistructured interviews and a logbook will be used to monitor adherence, arm use and acceptability. Primary outcome will be the feasibility of the methods and a full-scale trial employing predefined feasibility criteria (recruitment, retention and adherence rates, patients’ satisfaction with the home-exercise programme and their progress, affected hand use and acceptance of the intervention). Assessed at baseline, post intervention and 4-week follow-up, secondary outcomes include self-perceived hand and arm use, actual upper extremity function and dexterity, hand strength, independence in activities of daily living and health-related quality of life. Interview data will be analysed using qualitative content analysis. Medians (ranges) will be reported for ordinal data, means (SD) for continuous and frequency (percentage) for nominal data.Ethics and disseminationThis study follows the Standard Protocol Items: Recommendations for Interventional Trials-Patient-Reported Outcome (PRO) Extension guideline. Ethical approval was received from the Ethics Committee of the Medical University of Innsbruck, Austria (1304/2020). Written informed consent will be obtained from all participants prior to data collection. Study results will be disseminated to participating patients, patient organisations, via the clinic’s homepage, relevant conferences and peer-reviewed journals.Trial registration numberDRKS-ID: DRKS00023395.Study protocol, second revision, 5 December 2021.

The Effect of a Home Exercise Program on Visio-Vestibular Function in Concussed Pediatric Patients

ObjectiveTo explore if a home exercise program (HEP) affects visio-vestibular function in concussed pediatric patients.BackgroundA HEP can provide an equitable and cost-effective method for therapy targeted towards visio-vestibular deficits that are common following concussion. It is unclear if pediatric patients prescribed a HEP demonstrate improved visio-vestibular function.Design/MethodsThis observational study included 1,041 patients (59% female; age = 14.0 ± 2.5 years) reporting to a specialty care concussion center for an initial visit ≤28 days post-injury and follow-up ≤60 days post-injury. All patients completed a Visio-Vestibular Examination (VVE) at both timepoints consisting of 9 subtests: smooth pursuit, horizontal/vertical saccades and gaze stability, binocular convergence, left/right monocular accommodation, and complex tandem gait. Patients were prescribed a HEP (1–2 times/day) at initial visit consisting of exercises addressing visio-vestibular deficits. At follow-up, patients reported their progress: (1) has not done the HEP, (2) is currently doing the HEP, or (3) has completed the HEP. Primary outcomes included HEP progress, VVE subtests (normal/abnormal), and total VVE (abnormal = 2 + abnormal subtests). Chi-square tests with Bonferroni corrections were used to determine if abnormal VVE outcomes were associated with HEP status.ResultsAt initial visit, 81 2(77.6%) patients presented with abnormal total VVE. At follow-up, the proportion of abnormal total VVE did not differ among patients not doing the HEP (101 [62.0%]), patients currently doing the HEP (516 [69.0%]), and patients who had completed the HEP (51 [69.0%]). However among VVE subtests, a lower proportion who completed the HEP presented with abnormal smooth pursuit (7.5%), horizontal (3.8%) and vertical (3.8%) saccades, and complex tandem gait (0%) relative to patients currently doing the HEP (p = 0.003) and patients not doing the HEP (p = 0.01).ConclusionsOur findings indicate that patients who completed the HEP presented with improved elements of visio-vestibular function relative to those who did not start or were currently doing the HEP.

Comparison of exercise-based cancer rehabilitation delivered in-person or via telehealth (TeleCaRe): a randomised controlled trial protocol (Preprint)

BACKGROUND Access to rehabilitation to support cancer survivors to exercise is poor. Exercise-based rehabilitation may be delivered remotely but it is unknown how it compares to in-person cancer rehabilitation. OBJECTIVE To evaluate the effectiveness of an exercise-based cancer rehabilitation program delivered via telehealth compared to a traditional in-person model for improving quality of life of cancer survivors. METHODS A parallel, assessor-blinded, pragmatic, non-inferiority randomised controlled trial with embedded cost-effectiveness and qualitative analysis will be completed. One-hundred and twenty-four cancer survivors will be recruited from a metropolitan health network in Melbourne, Australia. The experimental group will attend an 8-week, twice weekly, 60-minute, exercise group supervised via videoconferencing supplemented by an online home exercise program and information portal. The comparison group will attend an 8-week, twice weekly, 60-minute, supervised exercise group in person, supplemented by a written home exercise program and information booklets. Assessments will be completed at week 0 (baseline), week 9 (post-intervention) and week 26 (follow-up). The primary outcome will be health related quality of life measured by the EORTC QLQ-C30 at week 9. Secondary measures include walking capacity (6-minute walk test), physical activity (activPAL accelerometer), self-efficacy (Health Action Process Approach Questionnaire) and recording of adverse events. Health service data including hospital length of stay, hospital readmissions, and emergency department presentations will be recorded. Semi-structured interviews will be completed and analysed using a framework approach to determine the impact of delivery mode on patient experience. The primary outcome will be analysed using linear mixed effects models. RESULTS Trial not yet recruiting. Anticipated commencement January 2022. CONCLUSIONS This trial will inform the future implementation of cancer rehabilitation by providing important data about safety, effectiveness, cost and patient experience. CLINICALTRIAL The TeleCaRe Trial has been approved by the Eastern Health Human Research Ethics Committee (E21-012-74698) and is funded by the Victorian Cancer Agency. This trial is prospectively registered with the Australian New Zealand Clinical Trials Registry ACTRN12621001417875. Registered 21st October, 2021.

Effects of midfoot joint mobilization on perceived ankle-foot function in chronic ankle instability. A crossover clinical trial

BackgroundChronic ankle instability (CAI) is a complex clinical entity that commonly includes ankle-foot impairment.ObjectiveTo investigate the effects of midfoot joint mobilizations and a one-week home exercise program (HEP) compared to a sham intervention and HEP on pain, patient-reported outcomes (PROs), ankle-foot joint mobility, and neuromotor function in young adults with CAI.MethodsTwenty participants with CAI were instructed in a stretching, strengthening, and balance HEP and were randomized a priori to receive midfoot joint mobilizations (forefoot supination, cuboid glide and plantar 1st tarsometatarsal) or a sham laying-of-hands. Changes in foot morphology, joint mobility, strength, dynamic balance, and PROs assessing pain, physical, and psychological function were assessed pre-to-post treatment and one-week following. Participants crossed-over to receive the alternate treatment and were assessed pre-to-post treatment and one-week following. Linear modelling was used to assess changes in outcomes.ResultsParticipants who received midfoot mobilization demonstrated significantly greater perceived improvement immediately posttreatment in the single assessment numeric evaluation (Sham: 5.0±10.2%; Mobilization: 43.9±26.2%; β: 6.8 p<0.001, Adj R2:0.17) and Global Rating of Change (Sham: −0.1±1.1; Mobilization: 1.1±3.0; β: 1.8 p=0.01, Adj R2:0.12). Following the mobilization intervention, participants demonstrated greater improved rearfoot inversion mobility (Sham: 4.4±8.4°; Mobilization: −1.6±6.1°; β: −6.37, p=0.01, Adj R2:0.19), plantarflexion mobility (Sham: 2.7°±6.4; Mobilization: −1.7°±4.3; β: −4.36, p=0.02, Adj R2:0.07), and posteromedial dynamic balance (Sham: 2.4±5.9%; Mobilization: 6.0±5.4%; β: 3.88, p=0.04, Adj R2:0.10) compared to controls at 1-week post-treatment.ConclusionParticipants with CAI who received midfoot joint mobilization had greater perceived improvement and physical signs that may benefit this clinical population.

Comparison of an exercise program with and without manual therapy for patients with chronic neck pain and upper cervical rotation restriction. Randomized controlled trial

Background Cervical exercise has been shown to be an effective treatment for neck pain, but there is still a need for more clinical trials evaluating the effectiveness of adding manual therapy to the exercise approach. There is a lack of evidence on the effect of these techniques in patients with neck pain and upper cervical rotation restriction. Purpose To compare the effectiveness of adding manual therapy to a cervical exercise protocol for the treatment of patients with chronic neck pain and upper cervical rotation restriction. Methods Single-blind randomized clinical trial. Fifty-eight subjects: 29 for the Manual Therapy+Exercise (MT+Exercise) Group and 29 for the Exercise group. Neck disability index, pain intensity (0–10), pressure pain threshold (kPa), flexion-rotation test (°), and cervical range of motion (°) were measured at the beginning and at the end of the intervention, and at 3-and 6-month follow-ups. The MT+Exercise Group received one 20-min session of manual therapy and exercise once a week for 4 weeks and home exercise. The Exercise Group received one 20-min session of exercise once a week for 4 weeks and home exercise. Results The MT+Exercise Group showed significant better values post-intervention in all variables: neck disability index: 0% patient with moderate, severe, or complete disability compared to 31% in the Exercise Group (p = 0.000) at 6-months; flexion-rotation test (p = 0.000) and pain intensity (p = 0.000) from the first follow-up to the end of the study; cervical flexion (p = 0.002), extension (p = 0.002), right lateral-flexion (p = 0.000), left lateral-flexion (p = 0.001), right rotation (p = 0.000) and left rotation (p = 0.005) at 6-months of the study, except for flexion, with significative changes from 3-months of follow up; pressure pain threshold from the first follow-up to the end of the study (p values range: 0.003–0.000). Conclusion Four 20-min sessions of manual therapy and exercise, along with a home-exercise program, was found to be more effective than an exercise protocol and a home-exercise program in improving the neck disability index, flexion-rotation test, pain intensity, and pressure pain threshold, in the short, medium, and medium-long term in patients with chronic neck pain and upper rotation restriction. Cervical range of motion improved with the addition of manual therapy in the medium and medium-long term. The high dropout rate may have compromised the external validity of the study.