Many individuals with mild cognitive impairment (MCI) and/or mild dementia experience both cognitive deficits and decline in motor function and postural balance. This results in an increased risk of falls. Conventional balance programs are not tailored for patients with cognitive impairment. Motor-cognitive exercises that are developed for these patients can be effective, but these rehabilitation programs are underutilized. Many patients who were referred exercise programs never attend; even fewer complete prescribed programs. For patients with cognitive impairment, transportation and scheduling are some of the key challenges that limit their adherence and commitment. However, unsupervised in-home exercise programs are not adequate for these individuals because of poor adherence, apathy, and inability to follow exercise instructions. Therefore, there is a need for a remotely- supervised in-home exercise program for older adults with MCI and/or mild dementia. To address this need, we propose to develop a tele-exercise system that allows a qualified therapist to remotely supervise and interact with the patient during goal-oriented game-like and low risk exercise tasks (TeleExergame) that have been designed to improve balance and cognition. The exercises are interactive balance tasks with explicit goal-oriented augmented visual feedback (i.e., the patient's movement controls a virtual object on the screen, thus providing real-time visual and audio feedback that is critical for engagement and motor learning). This is achieved by a wearable sensor worn on a body segment of interest (e.g., shin) that measures body joint kinematics (e.g., position of foot/ankle during a virtual obstacle crossing task). For this Fast-Track submission, we conducted a preliminary study in a cohort of 22 patients with amnestic MCI, which demonstrated the effectiveness of the proposed Exergame training paradigm in the target population. In Phase I, we will create the first prototype of an easy-to-use Exergame solution for in-home use that includes a telemedicine interface to assist the patient or his/her caregiver with sensor positioning, running the program, remote supervision, and monitoring of the patients during exercise. We will evaluate the feasibility, perception of benefit, and ease of use of the proposed system in the target population and focus group of therapists. In Phase II, we will complete the development of the TeleExergame system to enable HIPAA compliant remote supervision by a qualified therapist and provide quantitative metrics for remote monitoring and personalization of the exercise program by the therapist. We will then conduct a clinical study to evaluate the efficacy of the solution. The proposed interactive tele-rehabilitation system would have an immediate and appreciable impact on patient care by providing an interactive exercise program for individuals with MCI and/or mild dementia. However, MCI and dementia represent only a fraction of the potential market for the proposed technology, which could also be used in other patient populations that exhibit poor balance, such as Parkinson's disease, diabetics, stroke survivors with lower-extremity paresis, and older adults who cannot perform conventional exercises.
Public Health Relevance Statement: Project Narrative The number of older adults who suffer from motor-cognitive declines and associated increases in fall risk and fear of falling are increasing rapidly. Unfortunately, conventional balance programs are not tailored for, nor effective in patients with cognitive impairment, who also suffer from poor adherence in unsupervised settings. We propose to develop an interactive tele-rehabilitation program for adults with mild cognitive impairment or mild dementia that is specifically designed to improve motor performance using comprehensive and goal-oriented low risk exercise tasks that are remotely-supervised by a qualified therapist via a telemedicine interface.
Project Terms: Adult; 21+ years old; Adult Human; adulthood; Affect; Elderly; advanced age; elders; geriatric; late life; later life; older adult; older person; senior citizen; Algorithms; Ankle; Regio tarsalis; Tarsal Bone; Tarsus; Clinical Research; Clinical Study; Clinical Trials; Cognition; comorbidity; co-morbid; co-morbidity; Control Groups; Mental Depression; depression; Dropout; Equilibrium; balance; balance function; Exercise; Exhibits; Feedback; Focus Groups; foot; Patient Care; Patient Care Delivery; Goals; Health; Interview; Joints; Medical Device; Medicine; Memory; Motivation; Movement; body movement; Parkinson Disease; Paralysis Agitans; Parkinson; Parkinson's disease; Parkinsons disease; Primary Parkinsonism; Patient Monitoring; Patients; Perception; Posture; Publishing; Rehabilitation therapy; Medical Rehabilitation; Rehabilitation; rehab therapy; rehabilitative; rehabilitative therapy; Risk; Running; Supervision; Tablets; Target Populations; Technology; Time; Transportation; Weight; Measures; Caregivers; Care Givers; Schedule; Telemedicine; base; sensor; improved; Body Measures; Body measure procedure; Phase; Training; Visual; Individual; diabetic; satisfaction; Collaborations; Cognitive Disturbance; Cognitive Impairment; Cognitive decline; Cognitive function abnormal; Disturbance in cognition; cognitive dysfunction; cognitive loss; Impaired cognition; programs; frailty; Adopted; Frequencies; Home; Home environment; System; Amentia; Dementia; interest; collegiate; college; experience; Performance; success; visual feedback; cohort; kinematic model; kinematics; HIPAA; Kennedy Kassebaum Act; PL 104-191; PL104-191; Public Law 104-191; United States Health Insurance Portability and Accountability Act; Health Insurance Portability and Accountability Act; cognitive defects; Cognitive deficits; Participant; Position; Positioning Attribute; Lower Extremity Paresis; Crural Paresis; Coding System; Code; Modeling; Sampling; Functional impairment; functional disability; fear of falling; Intervention Strategies; interventional strategy; Intervention; Leg; Postural Balance; Postural Equilibrium; postural control; Musculoskeletal Equilibrium; Population Group; fall risk; Effectiveness; telehealth; Address; psychosocial assessment; psychosocial care; psychosocial studies; psychosocial support; Psychosocial Assessment and Care; Adherence; Motor; randomisation; randomization; randomly assigned; Randomized; Clinical Evaluation; Clinical Testing; clinical test; research clinical testing; Cognitive; enroll; Enrollment; SBIR; Small Business Innovation Research; Small Business Innovation Research Grant; Monitor; developmental; Development; Instruction; virtual; designing; design; Outcome; Balance training; locomotor learning; motor learning; mobile device; handheld mobile device; restore function; restore functionality; restore lost function; functional restoration; prototype; tele-rehabilitation; telerehab; telerehabilitation; patient population; primary outcome; mild cognitive disorder; mild cognitive impairment; improved motor function; motor function improvement; physical activity intervention; exercise intervention; fitness program; exercise program; exercise training; stroke survivor; physiotherapist; physical therapist; amnestic mild cognitive impairment; recruit; body sensor; body worn sensor; wearable sensor; wearable system; wireless sensor technology; wearable sensor technology; exergame
