Identifying the Problem

Transcription

1 A NIDRR Rehabilitation Engineering Research Center April 1, 2011 National Institute on Disability and Rehabilitation Research Grant # H133E070029, U.S. Department of Education, Identifying the Problem Poor transition from rehab to wellness/health promotion

2 Post- rehab Health Decline (PHD) Health & Function Telerehab Physical inactivity Risk Threshold Recovery (months) Yellow line = level of physical activity Contributing to PHD Number of device listed in the FDA database Scooter Power Wheelchair 2009 Source: US Food and Drug Administration

3 Disability and Low Energy Expenditure Deconditioning Syndrome (DALEEDS) Addressing the Problem Connecting rehab to health promotion through telerehabilitation

4 Getting Beyond the Plateau Health & Function Telerehab Exercise/Physical activity Minimum level of function Telerehab Physical inactivity Recovery (months) Yellow line = level of physical activity Telehealth Telerehabilitation Telecoaching Telemeasurement Teleexercise (Virtual Reality))

5 Rehab to Physical Activity Rehabilitation Setting Hospital Rehabilitation Center Long-Term Care Facility Outpatient Medical Center Tele-Rehab - Tele-Coach Rehab Med - Tele-Coach Rehabilitation Tele-Rehab Tele-Exercise Tele-Coach - CIFT Community Setting Home Program Fitness Center Recreation Facility Senior Center Tele-Coach - CIFT Community Physical Activity CIFT, Certified Inclusive Fitness Trainer Telecoaching

6 Telecoaching Realistic nutrition and activity goals are set Telecoach provides tailored communication support via phone and/or Telecoach and and asst. asst. coach coach revise create plan initial as needed plan Variety and choice are optimized to promote sustainability Referrals come from Rehab Service Providers Health Appraisal Profile (HAP) Step 1 POWERS Generates Goal Recommendations Step 2 Goal Selected from Recommendations by both the Coach and Participant Step 3 POWERS Generates Strategy Recommendations to Reach Selected Goal Step 4 Strategy Selected from Recommendations by both the Coach and Participant

7 P.O.W.E.R.S Type address Map Inputs: Community Needs Community Assets Community Barriers Community Needs Location 1440 w. Holland Ave. Need Need help to get to a fitness Center near my home. Eckhart Fitness Center Contact info jerryl@yahoo.com 7

8 Community Inclusive Mapping Systems Shopping Tom s Fruit market has horrible service for people with disabilities. The have no help to carryout groceries. Any recommendations for better service fruit markets in the loop?? Diabetes My feet are so swollen. Any suggestions for good walking shoes? Walking Club Westside Diabetes walking/rolling club will be meeting today at 2:00 p.m. Transportation Needs ride to Eckhart fitness center between am. Anyone going that way. I m in a manual chair but can transfer easily to car seat. Eckhart Fitness Center 1330 West Chicago Avenue Community Inclusivity Index ¼ mile from home ½ mile from home 8

9 Point 3: Using Technology to Resolve It: T.I.M.E Technologies for Interactive Movement and Exercise The T.I.M.E. Alternative Traditional PA Interventions Interventions Across the Physical Activity Spectrum Physical Activity Pyramid Of Energy Expenditure

10 The Power of TIME T.I.M.E. Virtual Environment The Advantages of TIME Environmental barriers (built & natural) Inclusion of exercisers with different abilities Social interaction Engagement Variety of options Access Participation Sustainability Health & Function Avatar The Future Slowdown or Break T.I.M.E. Recovery Teleexercise Telecoaching Teleassessment Rehabilitation Disability Deconditioning Cycle Deconditioning Cycle Impairments Environmen tal Total Energy Expenditure Physical Inactivity Resting Energy Expenditure Activity & Movement Sarcopenia Obesity Secondary Conditions Personal Care Assistance Community Participation Insulin Sensitivity Osteopenia Peak VO2 Pathway 1 Pathway 2 Physical Function Outcomes of Deconditioning Employment Health Care Utilization Quality of Life Strength & Power Impaired Balance Immobilization IADL Aging with a Disability Falls & Injuries Technology for Exercise Physiology Assessment Technology for Interactive Exercise

11 Framing the Issues While the problem is deconditioning, which leads to sarcopenia and obesity, the root of the problem lies in physical inactivity and lack of movement across the day. The days of conducting onsite clinical exercise trials are nearing its end. A new generation of home-based remote training has to occur to reach small sample populations. We need greater connectivity between rehab and home/community physical activity. We don t need to invent new technologies, we need to adapt the technologies that currently exist and will be developed in the future for people with disabilities. Telemeasurement

12 AIMFREE- Online solutions UIC Staff Assessment of Curb Cut Outside Fitness Facility Using a Smartphone AIMFREE Online Survey AIMFREE Assessment on Smart Phone Slope measurement display on a Smartphone AIMFREE assessment on a Smartphone 12

13 Online AIMFREE Solutions Equipment Barrier Example: Automatic Doors Why is this a barriers? Policies Barrier Example: Service Animals Good Example Poor Example How to fix this barrier? Swimming Pool Barrier Example: Ledge to hold on Sample websites ADAAG Reference Utility of Common Activity Monitoring Devices in Measuring Energy Expenditure in Manual Wheelchair Users with SCI Physical Activity Monitoring and Sharing Platform (PAMS) Web Server Database Wocket 3G/GSM/Wi-Fi Broadband Data logger Bluetooth Social Network Portal

14 Teleexercise Virtual Exercise Environments for People with Disabilities PI- Dr. Jane Mulligan, CU Goal: Create motivational, visually- stimulating virtual exercise environments (VEEs) that will promote greater adherence to exercise among people with disabilities.

15 D1. Virtual Exercise Environments for People with Disabilities Co-located VEE VoIP VEE synchroniza0on Current prototype sets up 2 internet connections: Voice over IP: users wear headsets and can converse while working out VEE synchronization: transmits speed and trail location information between user systems. Users with differing fitness abilities can still have their speed along trails synchronized. You can workout with someone across town or across the country. Network can also be used by therapists to monitor and encourage adherence and progress for prescribed activity. Record dates, speed, duration etc of VEE workouts. Could also match patients with similar needs and abilities as exercise buddies. Virtual Exercise Environments for People with Disabilities