Person-Centered HealthCare: Envisage Visual Rehab Project Promotes Independence
The Envisage Research Project is a collaborative endeavor in Scotland that uses visualization to help the elderly with their rehabilitation efforts. The University of Strathclyde’s Bioengineering Unit, The Glasgow School of Art’s School of Design, Glasgow Caledonian University’s School of Engineering & Computing, and a number of other partner institutions and organisations have developed a series of 'work packages' that help those with rehab needs visualize their treatment.
Envisage runs from Jan 2010 to October 2013 and is funded by Lifelong Health and Wellbeing (LLHW), a cross-research council initiative in partnership with the UK health departments and led by the Medical Research Council (MRC).
The aim of Envisage is "to evaluate the use of an innovative method of visualising scientific information about the stresses, strains, and movements of muscles and joints which is usually not possible for lay individuals, and non-specialist professionals to understand."
Lack of understanding or compliance can lead to poor rehabilitation. This leads to poor mobility, increased dependence on others, lower self-esteem or depression, increased possiblity of further illness and hospital re-admissions and increased healthcare costs.
A clear understanding of the rehabilitation treatment, on the other hand, can lead to increased compliance, increased independence and mobility and a healthier lifestyle.
Through the use of the Envisage system, it is hoped that users will better understand their rehabilitation treatment, be more compliant, achieve better functional outcomes and be more satisfied. This will lead to more efficient and less costly care.
The Envisage system is currently being evaluated through a series of five pilot clinical trials, using a range of technologies in a variety of home, community and hospital settings, across a variety of rehabilitation disciplines:
- Home-Based Falls Prevention Rehabilitation
- Home-Based Total Knee Replacement Rehabilitation
- Community-Based Lower Limb Stroke Rehabilitation
- Community-Based Upper Limb Stroke Rehabilitation
- Hospital-Based Ankle-Foot Orthoses (AFO) Tuning After Stroke
Once these small-scale trials are completed and evaluated it is hoped that larger-scale studies will follow and the technology will eventually become a standard part of stroke and musculoskeletal rehabilitation.
In the home setting, the lack of adherence to rehabilitation could have serious implications for the health and independence of seniors. Furthermore, if the recommended quality of motion (range and pace of movement) is not observed for these exercises, the seniors will probably not obtain the full recovery benefits offered by rehabilitation program(s). Two of the Envisage work packages are now undertaking full 6-12 week trials in patients’ homes. It is believed by the developers of Envisage that the sensor technology will only really be viable if it is small scale, low cost and available for people to use in the comfort of their own homes,
"We are very excited about the possible outcomes from these two home trials (one focused on falls and one on knee replacement) as we believe that seniors’ quality of life and ability to integrate back into daily activities will be greatly enhanced by this technology."
Stroke patients often have quite complex needs and the 3 Envisage stroke trials are taking place in community or hospital settings with therapists leading the sessions. At the moment physical and occupational therapists need to explain to patients how they are getting on with particular movements and exercises. Using Envisage patients are able to see and understand immediately the extent to which they are achieving their target position and respond by making adjustments instantly. Sensors placed on patients’ upper and lower limbs during therapy sessions monitor exercises and convert the movement data in real time into images. Patients see their movements being made by a “stick figure” with the extent to which a desired movement is being achieved indicated by a clear red to green spectrum. The system is tailored not only to the individual patient, but also to the specific therapy session with targets able to be adjusted as recovery proceeds.
Immediate Impact for Patients and Therapists
Envisage is already proving a hit with both healthcare staff and stroke patients. “It has been really helpful,” says 55-year old participant Linda Gordon. “Because you can actually see what you are doing, where you are going wrong you can immediately do something about it.”
NHS Occupational therapist Gillian Sweeney adds: "Occupational therapists and physiotherapists have always used verbal feedback and mirrors in therapy sessions as patients like to be able to know where they're going wrong and to get advice on how to correct this. Envisage means this is possible for them to see this immediately"
“Envisage is a tangible example of how design can have a positive impact on delivery of health care and on patient recovery,” says Dr Anne Taylor of the GSA, a Research Fellow on the Envisage project. “Recovery from a stroke is a long, slow process and keeping up with exercise a major challenge. From the evaluation of the trials to date clear patterns are emerging of improved patient understanding and communication as a direct result of them being able to see and immediately adjust their movements, as well as to see how they are reaching their rehabilitation targets.“
Watch this very short video of part of the WP2 showing some of the falling prevention exercises (these exercises were co-designed with the users).
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Joan Justice is currently the Senior Curator for HealthWorksCollective. She holds both a nursing and a graduate business degree, and has worked in domestic and international marketing management for several major healthcare corporations. She lives in Charlottesville, Virginia.