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Rehabilitation is defined as the very act of restoring someone to health or normal life after a period of illness, addiction or imprisonment. In other words, it refers to the prevention, diagnosis, and therapy for patients experiencing certain functional disabilities due to injury, disease or malformation. Though being widely used from the dawn of the 20th century, its origin dates back to yore.

Technological innovations, both existing and forthcoming, are expected to enhance the scope of diagnosis, treatment, patient recovery, and resident management. This article explores the various technological mediums that would go on to impact rehabilitation. 

Origins 

Rehabilitation therapy originated in the days of yore. On a more precise note, it stretches to thousands of years back, when the Chinese employed Cong Fu – a movement therapy that helped mitigate pain. The very first use of therapeutic exercise for the treatment of diseases and maintenance of health can be attributed to the Greek physician Herodicus, who prescribed a comprehensive system of gymnastic exercises.

Rehabilitation in its modern avatar started taking shape in the year 1929 when Dr Frank Krusen flagged off the first university department of PM&R (Physical Medicine and Rehabilitation) at Temple University Medical School. Dr Krusen acknowledged the vitality of physical medicine after contracting Tuberculosis (TB). This prompted him to have a prolonged stay in the sanitorium. During his stay there, he witnessed the intense deconditioning and functional deterioration faced by bed-bound patients, which he thought must be addressed. He went on to study deeply about the effects of physical agents on a human body and used physical therapy to help his patients recover. Thus, began the wave of rehabilitation. 

Ortho and Neuro Rehab

The field of Rehab is mainly classified into Ortho and Neuro Rehab. Here’s a brief account of these diverse therapies:

Orthopaedic Rehab – Individuals undergoing joint replacement and musculoskeletal injury are often limited in functions (mobility), and deal with pain and other complications. According to the World Health Organization (WHO), there are rising cases of Arthritis, Osteoporosis, Broken Bones, among others. Ortho Rehab mainly focuses on solving these issues and restoring old functions. Rehabilitation, curated by doctors according to individual needs, plays a pivotal role in ensuring a good quality of life under these circumstances. 

Early ambulation and ROM is very important to prevent complications connected with immobilization. It is highly advised that this rehabilitation process is initiated the first day after surgery. 

The purpose of Ortho Rehab is to help patients regain the use of limbs, incorporate assistive devices, prevent the occurrence of any lingering limitations, and prevent or delay the need for any surgery. 

Neurological Rehab – This program is meant for people who have been dealt with injuries, diseases or disorders of the nervous system. Its very purpose is to improve/restore functions (mobility) and improve the well-being of the patient. Some of the conditions that may warrant a Neuro Rehab include vascular disorders, infections, trauma, structural or neuromuscular diseases, functional and degenerative disorders.

Neurological rehabilitation differs a lot from other branches of neurology. As we know now, rehabilitation is a process that is performed by the patients themselves, but with the able guidance of a wide range of professionals. It exceeds the realms of physical disease and deals with the psychological repercussions of disability, as well as the social milieu in which the disabled person operates. It isn’t merely conducted by neurologists but necessitates active coordination with the health and social service fraternity.

Neurological Rehab involves neuroplasticity, the functionality of the brain that reorganizes synaptic connections. This means that an individual could fully recover after experiencing a traumatic brain injury.  

Challenges 

Rehabilitation in its traditional form, as many experts have even felt and expressed, has plenty of constraints that limit its success rates. A few of these are listed below: 

  1. To start with, it is boring. Because rehabilitation is naturally repetitive, it reduces the motivation of patients. 
  2. It is conducted with devices that have little or no computerized sensing, meaning – lack of widespread online databases.
  3. Lack of systems to monitor patients, which results in varying degrees of compliance with the prescribed exercise regimen, and a larger than necessary variability in treatment outcome. 
  4. The cost of rehabilitation is high owing to limited coverage and the expenses incurred for additional therapies. 
  5. The uneven distribution of therapists over territories. Patients are increasingly being forced to frequently travel to the location of these practitioners, which again leads to increased expenses and disruption in family life. To make it worse, the ratio of skilled physio to patients is small.
  6. Doctors are constantly challenged to find quality low-cost rehabilitation centres that elicit required exercises and sustain a patient’s motivation to engage in individualized and repeated practices. Most therapeutic activities occur outside the confines of a hospital due to time constraints and geological factors, which keeps the doctors unaware of recovery rates. A report of the NCBI (National Center for Biotechnology Information) suggests that 30-40% of patients discontinue their rehabilitation programs owing to time constraints, geological factors and demotivation.
  7. Pain management is traditionally tackled by medication. This may lead to side-effects such as sedation, constipation dizziness, nausea, among others. These side-effects could prolong a patient’s stay in the hospital.

The Virtual Reality Advantage 

Virtual Reality doesn’t alter the entire rehab process but adds to its layers by creating a gamified and engaging environment. It offers the following benefits to doctors and patients, among many others, some of which are already explored and some, being researched: 

Value Proposition for Doctors     

  1. Improves Efficiency in Therapy – Virtual Reality rehabilitation involves gamified environments, which helps patients to be thoroughly involved in the process. This, in turn, helps them to comply effectively with the prescribed exercise regimens and medications, resulting in increased overall efficiency.
  2. Measuring, Recording and Inputting Data – Doctors can now access individual activity and participation outcomes over a range of areas, including communication, mobility, self-care and quality of life. And this is done in substantially less time.
  3. Increased Patient Volume and Turnover – Considering the statistics from the aforementioned report by the NBCI,patients can benefit a lot from the Virtual Reality model of rehabilitation (covered below), which drives them to this most effective and essential practice.
  4. Economies of Scale – Virtual Reality is a one-time, profit-oriented investment. Doctors may use the same VR hardware for different exercises, and for different patients. The same head-mounted display that was used for post-traumatic disorders can be used for post-stroke patients, and so on and so forth.
  5. Here’s a Win-Win – Doctors are constantly challenged to find quality low-cost rehabilitation centres that elicit required exercises and sustain a patient’s motivation to engage in individualized and repeated practices. Most therapeutic activities occur outside the confines of a hospital due to time constraints and geological factors, which keeps the doctors unaware of recovery rates. Virtual Reality allows patients to do their exercises at the convenience of their homes while maintaining interactions with therapists. And as observed, doctors can track the progress of patients more efficiently than ever before. Virtual Reality provides them access to all the essential data and even negates the need of goniometers for certain measurements. 

Value Proposition for Patients

  1. Reduction in Readmissions – Virtual Reality promotes effective coordination between doctors and patients and encourages patients to comply with the prescribed exercise regimen post-discharge. Affordable and reliable transportation (transportation itself is strenuous) will cease to be a need.  Patients may rather interact with the doctor virtually, and the doctor could track their progress and compliance. Besides that, the engaging nature of Virtual Reality would motivate the patients to pursue the practice continuously.  
  2. Home-Based Exercises, Transportation – Most patients skip rehabilitation because of the lack of motivation or boredom, considering the hassles of the process like frequent doctor visits, the need for appointments, routine, etc. Add to it, the ratio of skilled physios to patients is small and entirely unreliable. Patients often must travel a long way for each of their rehabilitation sessions.  Virtual Reality rehabilitation doesn’t necessitate patients to frequently drop into the doctor’s clinic unless thoroughly necessitated; It can be used at homes and in hospitals, which means that patients need not drop out of therapy sessions if they cannot afford the hospital expenses. At the same time, they would be able to maintain frequent interactions with the therapist. The technology can deliver engaging, quantified, cost-effective, individualized, and high-repetition movement practice to patients who may have to undergo repeated arm movements to receive his/her peak level of motor functioning.
  3. Cost-Efficiency – While it is now obvious that Virtual Reality saves transportation costs and the frequent need of visiting doctors, it also helps people to partake in additional therapy sessions with no extra costs. Patients are usually required to pay more in order to avail such privileges.  On the other hand, a lot of patients opt to be discharged out of the expensive acute unit and thereby miss out on the essential care required for many ailments, especially that of slowly progressive conditions such as cerebral palsy or Parkinson’s disease. The availability of the alternative of Virtual Reality helps tackle these issues.
  4. Neuroplasticity – Rehabilitation facilitates neuroplasticity, i.e. the brain’s ability to form and reorganize synaptic connections.  This effectively means that the brain could recover from traumatic injuries. However, the mindless and repetitive performance of tasks wouldn’t help the brain in forming any connections. It does it better when the task involves functional and meaningful goals.  Virtual Reality fulfils this need by delivering interactive contents in an immersive setting.
  5. Functional Interactivity – Virtual Reality allows users to interact with the virtual world in three dimensions and has proven to be more effective than two-dimensional virtual reality practices with little/no interactivity. It offers patients a much-needed leeway through home-based interactive therapies.  
  6. Improved Movements and Techniques – Market implementers have found that a combination of auditory and visual cues from a Virtual Reality avatar could improve outpatient physical therapy movement guidance and technique. It could lead to increased compliance and thereby, effectiveness. Lower compliance rates are often due to boredom and lack of confidence in movement accuracy, both of which are effectively tackled by Virtual Reality.
  7. Pain Management – Virtual Reality is emerging as a non-pharmacologic therapy for pain, and an increasing body of evidence points towards the effectiveness of VR in reducing pain in both inpatient and outpatient settings. 

Virtual Reality is built with the potential to transform many industries. In the given context, it offers solutions to many discomforting issues faced by doctors and patients alike. It is here to change the game and provide real meaning and depth that this medical speciality so deserves.

Deep Learning

Levodopa is a standardized therapy for Parkinson’s disease, but people who take Levodopa experience side effects like muscle spasms, involuntary movements and other motor complications, which include Levodopa Induced Dyskinesia (LID). While Levodopa usage is standardized and must be used in sufficient quantities, neurologists are challenged to adjust its dosage in a way that the symptoms of Parkinson’s are reduced without the side effects. Also, the evaluation of side-effects varies from one neurologist to another.

Research teams are employing Deep Learning, a form of AI. The algorithm, which involves the measurement of a patient’s severity of spasms and involuntary movements through short videos, is the first of its kind and looks promising for assessment scenarios.   

Assistive Technologies 

The modern-day medical equipment includes robotics and anti-gravity treadmills that aid residents with movements and ambulation. This is to be bolstered by robotic exoskeletons, which would help the recovery of residents who might not be able to stand or walk without assistance. Anti-gravity robotic treadmills would enable residents suffering from neurological conditions to regain or improve their ability to move and walk.  Advances in robotics and software would help therapy professionals in reaching out to more residents, maintain precision in diagnosis, and enhance their clinical efficiencies. It importantly leads to increased engagement and consequently, greater outcomes. 

Brain-Machine Interface

The future years, the next 20 or so to be precise, would unfold progressive developments in Brain-Machine Interface Technology (BMIT). Experts say that it could even help people experiencing paralysis, especially on account of ALS, in communicating with synthesized speech, printed text and email, and drive mobility-enhancing devices like motor wheelchairs. More research is being conducted to gauge its entire scope of utilities and what it means for rehabilitation, but its potential is undoubted.   

Wheelchair Technology

The wheelchair was, is, and will be (at least for some time) the most important means for mobility and functioning for people with disabilities. But what is intriguing here is that the wheelchairs of the future would be greatly different than the ones used today. This can be attributed to the widespread developments that would change the face of smartphone technology, cloud-based computing, and alternative power sources that facilitate greater software customization and upgrades.

Robotics, flexible and additive manufacturing, intelligent multiconfiguration wheelchairs, integrated robotic manipulators and direct brain interfaces would join forces to transform the very design of wheelchairs and the way it can be used. We’ll have a future where wheel-chair users can lead a life of harmony but without over-reliance.

Regenerative Medicine

Damaged tissues? No worries, future forecasts suggest that it can be regenerated. Any development in this field must be attributed to John Gurdon and Shinya Yamanaka, for it is they who discovered that mature and specialized cells can be reprogrammed to become stem cells, which can later develop into all tissues of the human body.  The duo was notably accredited with “The Nobel Prize in Physiology or Medicine in 2012” for their findings. This very interesting technology/concept, along with cell-based therapies and task-based rehabilitation, could optimize recovery rates. 

What to Expect?

Rehabilitation isn’t dead, as some experts of the 20th century vouched. Or maybe it was, until when the aforementioned technological avatars provided a new meaning to the term, by encouraging us to recognize and leverage the powers that rehabilitation brings.

At TNQ InGage, we develop state-of-the-art Virtual Reality healthcare solutions for rehabilitation, medical training, vision care assessment, patient experience, physician empathy, and more. Join hands with us to see what the virtual world holds and how transformative it is. We just don’t work with technology, but with solutions that are proven and life-changing.