Authors (including presenting author) :
Cheung P (1), Chau HY (1), Tsang KY (1), Chan YL (1)
Affiliation :
(1) Occupational Therapy Department, Kowloon Hospital
Introduction :
During the waves of coronavirus pandemics, the social distancing measures were leading to mobility restrictions and suspending face-to-face rehabilitation services. These changes may directly or indirectly affect the rehabilitation outcome of the patients with stroke. The delayed delivery of medical and rehab service may have negative impacts on the patients including increase of carer stress, worsening of patients’ mental wellness and quality of life according to various research findings. In light of providing timely and effective stroke rehab service to promote patient’s recovery irrespective of social distancing constraints, Kowloon Hospital Occupational Therapy Department devised a pilot tele-rehab intervention group with the application of motion analysis technology. The motion analysis technology allowed therapist to provide real-time guidance with visual feedback and quantitative data on patient’s performance in daily living activities to facilitate upper limb training at home.
Objectives :
- Provide more objective and accurate evaluation and feedback to patient’s performance in remote mode
- Maintaining the continuum of active and quality rehabilitation despite COVID-19 has widely affected the direct delivery of health care service.
- Enhance patient’s self-management of illness at home and community environment through tele-rehabilitation service
- Complement social distance policy and promote the prevention on COVID infection
Methodology :
This was a pilot intervention group with the inclusion criteria: (1)Existing stroke patients who already received OT face-to-face assessment, (2) Onset within 1 year, (3) AMT ≧ 6/10 & able to follow at least 3 steps verbal instructions, (4) FTHUE level ≧ 3/7, (5) Able to access remote training through tele-communication software - Zoom, (6) Without obvious potential complications, e.g. shoulder mal-alignments, pain, etc.
Total of 4 distance rehab sessions by means of communication software - Zoom, with duration of each session was 30 mins. Before the first session of the group, a short video clip on the patient's upper limb movement in daily living tasks was collected and analyzed through motion analysis freeware- Kinovea with their consent. In the 4 sessions, the following contents were delivered: (1) Education on spasticity management through proper positioning and splintage, (2) Evaluation of affected and unaffected upper limb movement pattern with capturing of kinematic data, such as travel distance, velocity and smoothness of movement, in daily functional reaching tasks through remote motion analysis, (3) Feedback on upper limb functional movement pattern and home program practice, (4) Functional goal setting.
Service satisfaction survey from the patients was collected after the training group. In the survey, the following items were included: (1) Understanding the importance of self-participation in home rehab program, (2) Understanding the post-stroke spasticity management, (3) The effectiveness of motion analysis to facilitate home rehab program, (4) The ease of understanding and engaging in this zoom rehab program, (5) The overall satisfaction towards this zoom rehab program.
Result & Outcome :
14 OT out-patients were recruited in this rehab service program. All the recruited patients (100%) had enhanced their awareness towards the importance of home program training and the participation in home program. By revealing the kinematic data difference between affected and unaffected hand function, both therapists and the stroke patients clearly understood the quality of the designated functional movement pattern and hence early and more accurate correction of the maladaptive movement pattern in activities of daily living can be committed to promote the patient's recovery. Although 7.1% of the recruited patients had raised the need of assistance from therapist and care-giver to set up and operate the tele rehab session, all of them perceived positive gain and experiences in this pilot tele-rehab group. With the aid of motion analysis in tele-rehab, patients were able to receive timely and qualitative rehabilitation at home in compliance with the government's social distance policy during the COVID pandemic peak.
