New Telerehabilitation Services for the Elderly

New Telerehabilitation Services for the Elderly

António Teixeira (University of Aveiro, Portugal), Carlos Pereira (University of Aveiro, Portugal), Miguel Oliveira e Silva (University of Aveiro, Portugal), Joaquim Alvarelhão (University of Aveiro, Portugal), Anabela G. Silva (University of Aveiro, Portugal), Margarida Cerqueira (University of Aveiro, Portugal), Ana Isabel Martins (University of Aveiro, Portugal), Osvaldo Pacheco (University of Aveiro, Portugal), Nuno Almeida (University of Aveiro, Portugal), Catarina Oliveira (University of Aveiro, Portugal), Rui Costa (University of Aveiro, Portugal), António Neves (University of Aveiro, Portugal), Alexandra Queirós (University of Aveiro, Portugal) and Nelson Rocha (University of Aveiro, Portugal)
DOI: 10.4018/978-1-4666-3990-4.ch006
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Abstract

The world’s population is getting older with the percentage of people over 60 increasing more rapidly than any other age group. Telerehabilitation may help minimise the pressure this puts on the traditional healthcare system, but recent studies showed ease of use, usability, and accessibility as unsolved problems, especially for older people who may have little experience or confidence in using technology. Current migration towards multimodal interaction has benefits for seniors, allowing hearing and vision problems to be addressed by exploring redundancy and complementarity of modalities. This chapter presents and contextualizes work in progress in a new telerehabilitation service targeting the combined needs of the elderly to have professionally monitored exercises without leaving their homes with their need regarding interaction, directly related to age-related effects on, for example, vision, hearing, and cognitive capabilities. After a brief general overview of the service, additional information on its two supporting applications are presented, including information on user interfaces. First results from a preliminary evaluation are also included.
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Introduction

The world’s population is getting older with the percentage of people over 60 increasing more rapidly than any other age group. The World Health Organization estimates an increase of 223 percent in the number of older people between 1970 and 2025 (WHO, 2002). By 2025, it is anticipated that there will be 1.2 billion humans over the age of 60 and this will continue to rise to about 2 billion in 2050. Ageing brings a decrease in functioning associated with an increase in a variety of chronic diseases, which leads to greater use of healthcare services (WHO, 2002). This challenges the traditional healthcare system and the scarcity and cost of health resources are likely to limit the health system’s ability to appropriately respond to a population that not only wants to live longer, but to live with more autonomy and quality of life (Kairy, Lehoux, Vincent, & Visintin, 2009). One of the most common problems with elderly people is mobility. The need to attend a Health facility (e.g.: clinic) has repercussions in their daily life and that of their families.

The use of technologies in health has seen a remarkable development in recent years, bringing a new or unique terminology. If the word 'telemedicine' appears in the first articles in this issue, nowadays the concept of telehealth appears to be the one that best reflects the potential of this subject:

“Telehealth is the use of electronic communications to support long-distance clinical health care, patient and professional health-related education, public health and health administration” (HRSA).

With suitable natural interfaces and the possibilities offered by the next generation networks (NGNs), the introduction of technological solutions can facilitate the daily life of the elderly, fighting isolation and exclusion, increasing their pro-activity, work capacity, and autonomy.

As part of telehealth, telerehabilitation is the use of electronic communication and information technologies to provide rehabilitation at a distance. It comprises two categories: assessment (the patient’s functional abilities in his or her environment), and therapy. Teleconferencing or teleconsultation are no longer the primary services that can be distance provided. In fact, in telerehabilitation we can now include digital monitoring, patient surveillance and real time applications (Shaw, 2009). As an alternative to face-to-face rehabilitation approaches, it offers the possibility to overcome geographical barriers or act as a mechanism to extend limited resources and enhance outcomes in populations with special needs (McCue, Fairman, & Pramuka, 2010).

Telerehabilitation has been explored in several fields: neuropsychology; speech, language and hearing; occupational therapy and physical therapy. For example, Tele-audiology (hearing assessments) is a growing application.

The concern of different professionals on this topic has resulted, for example, in the American Physical Therapy Association defining guidelines for the practice of telehealth. In this document, telehealth also encompasses a variety of health care and health promotion activities, including, but not limited to, education, advice, reminders, interventions, and monitoring of interventions (APTA, 2009).

The pressure to provide quality services for an increasing population is felt in the elderly care sector. Telerehabilitation may help minimise the pressure put on the healthcare system by the continuous ageing of the worldwide population. The scarcity and cost of health resources limits the health system’s ability to properly respond to a population that not only wants to live longer, but live with more autonomy and quality of life.

Technologies usable by older adults, with their specificities, to provide new services in the areas of telerehabilitation and Ambient Assisted Living (AAL) are needed. In this paper, we present work in progress in such a new service, for telerehabilitation and/or telefitness. In very general terms, the service provides supervised remote exercise sessions at home or community centres, as a means to maintaining health and preventing illness.

Key Terms in this Chapter

Cloud Computing: Is a model for enabling convenient, on-demand network access to shared computing resources (such as servers, storage, applications, and services) that can be rapidly provisioned and released with minimal management effort or service provider interaction. It is this concept that is generalized in Cloud Rehabilitation.

Telerehabilitation: Is the use of electronic communication and information technologies to provide rehabilitation at a distance.

Active Aging: Is the process of optimizing opportunities for health, participation, and security in order to enhance quality of life as people age (WHO, 2002).

Persona: A persona , adopting the definition by ( Blomkvist, 2002 ), is a model of a user that focuses on the individual’s goals when using an artefact. The model has a specific purpose as a tool for software and product design. It is an archetypical representation of real or potential users, not a description of a real, single user or an average user. The persona represents patterns of users’ behaviour, goals and motives, compiled in a fictional description of a single individual. It also contains made-up personal details, in order to make the persona more “tangible and alive” for the development team. The idea of personas originated from Alan Cooper, an interaction designer and consultant (see Cooper, 1999 ).

Cloud Computing: Is a model for enabling convenient, on-demand network access to shared computing resources (such as servers, storage, applications, and services) that can be rapidly provisioned and released with minimal management effort or service provider interaction. It is this concept that is generalized in Cloud Rehabilitation.

Treatment Effectiveness: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease.

Rehabilitation: Rehabilitation aims at enabling individuals to reach and maintain an optimal physical, sensory, intellectual, psychological, and social functional level (WHO; http://www.who.int/topics/rehabilitation/en/).

AMITUDE: Is a generic model of use and presents the aspects: Application type, Interaction, Task, other activity, domain, User, and Environment of use.

AMITUDE: Is a generic model of use and presents the aspects: Application type, Interaction, Task, other activity, domain, User, and Environment of use.

Multimodality: A modality, or, more explicitly, a modality of information representation, is a way of representing information in some medium (Bernsen & Dybkjaer, 2009). By definition, a multimodal interactive system uses at least two different modalities for input and/or output. Multimodality allows an integrated use of various forms of interaction simultaneously.

Rehabilitation: Rehabilitation aims at enabling individuals to reach and maintain an optimal physical, sensory, intellectual, psychological, and social functional level (WHO; http://www.who.int/topics/rehabilitation/en/ ).

Multimodality: A modality, or, more explicitly, a modality of information representation, is a way of representing information in some medium ( Bernsen & Dybkjaer, 2009 ). By definition, a multimodal interactive system uses at least two different modalities for input and/or output. Multimodality allows an integrated use of various forms of interaction simultaneously.

Active Aging: Is the process of optimizing opportunities for health, participation, and security in order to enhance quality of life as people age ( WHO, 2002 ).

Treatment Effectiveness: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease.

Telerehabilitation: Is the use of electronic communication and information technologies to provide rehabilitation at a distance.

Persona: A persona, adopting the definition by (Blomkvist, 2002), is a model of a user that focuses on the individual’s goals when using an artefact. The model has a specific purpose as a tool for software and product design. It is an archetypical representation of real or potential users, not a description of a real, single user or an average user. The persona represents patterns of users’ behaviour, goals and motives, compiled in a fictional description of a single individual. It also contains made-up personal details, in order to make the persona more “tangible and alive” for the development team. The idea of personas originated from Alan Cooper, an interaction designer and consultant (see Cooper, 1999).

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