Virtual Rehabilitation: New Approaches in treating Mild Cognitive Impairment.

Continuity of medical services and accessibility of care are hallmarks of a successful healthcare system. Unfortunately this vision is not always attainable for a professional rehabilitation considering its habitually high costs. Specifically, if we talk about multiple intuitively demarcated deficiencies such as, e.g., Mild Cognitive Impairment (MCI), which is loosely defined by Mayo Clinic  as an “intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia”.

Is MCI really a disease or is it a signature of a normal aging process, perhaps aggravated by some bad  life habits, e.g., smoking, alcohol or lack of physical exercise? Considering some of the alleged MCI symptoms [1] such as “forgetting things more often” or “losing your train of thought or the thread of conversations, books or movies” (which may very well happen to a young person when one stares at the TV screen with a glass of wine after a long and stressful day) many of us could be on the way to MCI if not already there. Can we better understand the real causes and possibly prevent cognitive deteriorations such as MCI, dementia or Alzheimer’s disease (AD)?

Recalling the rapid population aging, especially in the developed countries which, according to WHO, will reach by 2050 approximately 2 billion people aged over 60 thus accounting for 22% of world’s population, the preventive measures against MCI will be crucial for the world social and economic stability. We should start exercising our brain, just as we are getting used to keep our bodies fit.

How can we train something so intangible as Mind and Soul in a way that every person can easily afford it?

To address this challenge the Spanish group of medical researchers and IT experts designed NeuroAtHome, a virtual rehabilitation platform for people diagnosed with Mild Cognitive Impairment. The system includes more than 100 rehabilitation tasks destined to treat specific motor or cognitive functions.NeuroatHOMEMCI2An individual is offered a set of cognitive and physical 3D videogame exercises tailored to his/her capacities and needs. A natural user interface allows one to work on the task distantly with hands’ gestures (or even eye movements), so that a physician can check both cognitive status and the precision of the motoric.  The complexities of the task corresponds to the Global Deterioration Scale (GDS), developed by Dr. Barry Reisberg that provides an overview of the stages of cognitive function for those suffering from a primary degenerative dementia.

Each rehabilitation task performed by a patient is quantified: Neuro@Home Pro measures the number of successfully completed tasks, response time and total number of completed tasks. The rehabilitation team can evaluate the progress not only by observations, but by “measurable” facts. New rehabilitation tasks may be added, existing ones modified or the program can be entirely stopped if not considered useful anymore. In a word: the therapy can be personalized and adjusted to the individual needs of a patient.

NeurAtHomePNG.PNGExamplesOne part of NeuroAtHome is installed in an individual’s home, another one in a clinic. A physician can monitor his patient remotely from any location (e.g., from the hospital or physician’s house), while patients can definitely cut on long distance travelling.The system is utilizing Microsoft Kinect sensors such as IR Emitter and IR depth sensor for capturing body motions, including facial contractions, and to create digital skeleton. Tilt sensors are calculating the correct angle and position of the body while color sensors detect the slightest fluctuations in the skin color such as emerging paleness or redness.   As blood passes the vessels, Kinect camera recognizes the variations of the facial color intensity to establish how fast the blood is pumping. This helps the physician to objectively detect the level of the stress a patient experiences from exercises and to adjust the program.NeuroAtHomeMCI

The results of the performance are stowed in Microsoft Cloud Azure platform for further analysis. Physical data are collected and stored into patient’s profile by Kinect, so the next time one reaches the system it recognizes its user.With NeuroAtHome monthly subscription one can have an  access to multiple virtual training programs.

The overall rehabilitation is now considerably cheaper than the traditional treatments provided by  clinics where normally a patient is discharged not when she or he is fit, but when the insurance expects her/him to leave.

More and more clinics are looking for new ways to make the rehabilitation therapy more affordable to provide the high quality treatment  as long as individual requires.  One of such clinics is Hospital La Pedrera that has already treated 175 patients using the NeuroAtHome rehabilitation platform. When asked if they would like to continue the training, 99.4% of patients found the virtual therapy highly motivating. NeuroAtHome allowed patients to receive, on average, 30% more physical therapy sessions and 15% more cognitive therapy sessions using the same available resources. The increased efficiency resulted in improved patient outcomes: patients that used NeuroAtHome were discharged, on average, 3 days earlier.

During the first quarter of 2015, NeuroAtHome reached 4,000 patients delivering over 300,000 sessions, in both medical and home environment.

The spectrum of personalized training programs address multiple aspects of impairments: from muscular–skeleton, to brain and spinal cord injuries, from chronic and neurodegenerative conditions to active aging.

If the technology can capture and analyze practically unlimited number of individual cognitive sings for providing personalized therapy, could it now offer a more measurable insight into the nature of cognitive impairments? I believe it is the time one tries it.



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