NeuroRehabilitation - Volume 12, issue 1

Authors: Rosen, Michael

Article Type: Introduction

DOI: 10.3233/NRE-1999-12101

Citation: NeuroRehabilitation, vol. 12, no. 1, pp. 1-2, 1999

Authors: Lathan, Corinna E. | Bogner, Marilyn Sue | Hamilton, Douglas | Blanarovich, Adrian

Article Type: Research Article

Abstract: Home health, including self-care, has been recognized by an FDA study as one of six major future trends in medical device technology. The need for home care has increased due to many factors including the ever-expanding capability of medicine to increase longevity through interventions, which has lead to an aging population dependent on medical support for their well-being. Effective design of home care medical devices depends on the understanding the information processing capabilities of the user; The user may be the caregiver or providing self-care. The most successful technologies that have been employed in home care application enable the user …to do less while providing the same or better “wellness” and/or “activities of daily living”. Existing technologies need to be examined to see if they are optimized for use in the home. Future technologies including telecommunications and virtual reality may be further developed for home use. Show more

Keywords: information processing, home care, human factors

DOI: 10.3233/NRE-1999-12102

Citation: NeuroRehabilitation, vol. 12, no. 1, pp. 3-10, 1999

Authors: Rosen, Michael J.

Article Type: Research Article

Abstract: In the last three years, the delivery of rehabilitation services at a distance by means of electronic information and communication technologies has come to be known as telerehabilitation. It is part of both the larger spectrum of telemedicine activities that have waxed, waned and waxed again since the early seventies; and the growing array of non-medical applications of consumer electronics and communication technology that can provide “tele-enhancement of independent living” for individuals with neurological and other disabilities. While telerehabilitation is still largely hypothetical, activities are underway at several clinical rehabilitation centers. Most commonly, inexpensive video phone connections are used …to provide face-to-face two-way image and voice contact between patient and provider, but transmission of data from sensors that monitor health and rehabilitation is technically feasible and promising. Telerehabilitation provides access to quality services for patients who are immobile or geographically remote from direct service. Some view it as a means of compensating for shortened lengths of stay in acute rehabilitation hospitals, while others emphasize the cost reductions it offers. Telerehabilitation methods, both current and in-the-works, are promising but it remains to be seen whether and how the reimbursement policy-makers at HCFA and private payers will respond to its potential. Show more

Keywords: telemedicine, telehealth, telerehabilitation, rehabilitation engineering

DOI: 10.3233/NRE-1999-12103

Citation: NeuroRehabilitation, vol. 12, no. 1, pp. 11-26, 1999

Authors: Mineo Mollica, Beth

Article Type: Research Article

Abstract: Augmentative and alternative communication (AAC) technologies are underutilized in the treatment of acquired communication disorders for a variety of reasons. A potential AAC user may prefer to regain lost skills rather than have to replace them with a less natural means of communicating. The technology may be rejected because of its appearance, its inefficiencies in supporting typical communicative exchanges, or the complexities of its use. Further, many individuals who have sustained injury to their brains exhibit highly idiosyncratic language disturbances requiring specialized applications of technology that simply do not exist. This review article examines several current and emerging technologies with …potential to impact the often complex cognitive and linguistic sequelae of neurological injury. This review begins with a synopsis of progress in areas such as speech input and output, natural language processing, interface technologies, and graphics that make consideration of a new generation of devices possible. This is followed by a discussion of specific aspects of communication breakdown that might be minimized or eliminated through applications of technology that address restoration of communicative function as well as compensation for the loss of function. Lastly, the review addresses the conceptual and attitudinal shifts that must occur if AAC technologies are to be useful to and accepted by individuals with acquired communicative disorders and their families. The key to successful application of emerging technology rests with language researchers, clinicians and consumers; they must provide guidance to product developers so that new device designs address communication needs in effective and acceptable ways. Show more

DOI: 10.3233/NRE-1999-12104

Citation: NeuroRehabilitation, vol. 12, no. 1, pp. 27-37, 1999

Authors: Cole, Elliot

Article Type: Research Article

Abstract: This paper is the first survey of the cognitive prosthetics field. Neurorehabilitation based on cognitive prosthetics is now reimbursed as a conventional therapy by many national insurance companies. The need for cognitive prosthetics is described in terms of gaps in rehabilitation methods, and a response to managed care limitations on duration of services. A definition is developed from work in the field, and a cognitive prosthesis is distinguished from both electronic aids as well as from conventional computer software. Some key concepts from computer science are reviewed, along with their significance to cognitive prosthetics. Key studies are reviewed, and show …the accomplishments of researchers, differences in their orientation, as well as the impact of computer and communications advances over the past decade. There is a discussion of future research. A key problem is the need to make cognitive prosthetics rehabilitation more user friendly to the therapist. This will be necessary if cognitive prosthetics is to gain widespread use in rehabilitation facilities. Show more

DOI: 10.3233/NRE-1999-12105

Citation: NeuroRehabilitation, vol. 12, no. 1, pp. 39-51, 1999

Authors: Durfee, William K.

Article Type: Research Article

Abstract: Electrical stimulation is a promising method for restoration of muscle and limb function for individuals with a variety of motor disabilities. Rehabilitation applications of functional electrical stimulation (FES) include restoration of standing and gait, activation of rudimentary grasp, motor retraining and bladder management. Simple standing and gait systems are technically feasible and have been demonstrated in the laboratory and with at least one commercial product. Further development must address fatigue, control, and ease-of-use challenges. Systems to restore grasp can have a significant impact on the ability of an individual with quadriplegia to live independently. A variety of systems that use …surface, percutaneous and implanted hardware are commercially available. Individuals with motor disabilities as a consequence of stroke represent the largest potential target population for FES systems. To date, applications have been limited because of the difficulty of demonstrating the efficacy in motor retraining or other applications when compared to conventional physical therapy methods. Recent research and development efforts have led to renewed activity in stroke applications and FES approaches to bladder management for those with spinal cord injury reveal great potential. First-generation implanted systems are in use and second generation systems are being researched. Many challenges must be addressed before FES systems can be used by large numbers of individuals with motor impairments. Among these challenges are the rapid fatigue of stimulated muscle, the limited pool of candidates who meet all of the ideal selection criteria for FES systems, and the need to demonstrate efficacy so that health insurance providers will cover FES systems. Show more

Keywords: muscle stimulation, FES, paraplegia, quadriplegia, spinal cord injury

DOI: 10.3233/NRE-1999-12106

Citation: NeuroRehabilitation, vol. 12, no. 1, pp. 53-62, 1999

Authors: Trepagnier, Cheryl G.

Article Type: Research Article

Abstract: Features of “virtual reality” (VR) systems and their value for the investigation and rehabilitation of cognitive and perceptual impairments are briefly described. Current and potential applications of VR technology to address six neurorehabilitation issues are discussed: (1) attention and the reduction of distraction, (2) assessment and remediation of executive function deficits, (3) investigation of impairments of coordinated movement, (4) study and rehabilitation of aphasia and other severe disorders of language, (5) task presentation for functional imaging studies of the brain, and (6) the measurement of mental load in the operation of assistive technology. Finally, a virtual reality system integrated with …gaze angle sensing technology is described, and its potential for investigation and rehabilitation of face processing by individuals with autism is discussed. Show more

Keywords: virtual environments, rehabilitation, autism, aphasia, cognitive, impairment

DOI: 10.3233/NRE-1999-12107

Citation: NeuroRehabilitation, vol. 12, no. 1, pp. 63-72, 1999