In today’s digital world, technology has a new role to play in increasing the efficiency of healthcare and reducing costs whilst at the same time ensuring that standards of care are continually being maintained and improved. Whilst innovation is core to healthcare, the field of rehabilitation is lagging behind, with its human and patient centricity making it more challenging to innovate.
But engaging equipment that can track outcomes remotely can support the self-management of rehabilitation and help people reach their rehab goals. Dr Paul Rinne is CEO and co-founder of GripAble, a smart mobile assessment and training device that connects to an app, to help people with upper limb impairment train hand and arm movements.
He explores technology in the rehabilitation landscape, including the opportunities and challenges it brings to patients and therapists alike, and explains how GripAble was developed with the user at front and centre.
The place of technology in rehab
For years, therapists have struggled to find the appropriate tools that can engage their patients in rehab, allow for greater efficiency in their workflow, and track outcomes remotely. As a neuroscientist carrying out my PhD at Imperial College London working closely with therapy teams on stroke wards, the need for an accessible mobile opportunity for patients undergoing physical and occupational therapy became clear.
We wanted to improve the translation of technology developed by the university into the real world. We were mindful that technology should complement traditional therapy rather than create a new clinical experience. Undeniably, tech needed to provide a continuation of the gold standard of care delivered by trained, expert therapists.
But it was apparent that traditional therapy equipment – like foams, cones and putty – wasn’t cutting it and couldn’t provide real-time motivation, feedback or data for tracking progress, leading patients to become disengaged in their rehab regimes once unsupervised.
Technology has the capacity to facilitate a level of self-management whilst assisting and supporting movement, allowing for high repetition therapy to engage and encourage a patient and thus increasing the amount of time they are engaging with their therapy programme. Not only this, but tech can facilitate gamification to motivate and challenge the user and provide real time feedback, and supports therapists in their roles by improving outcome recording and allowing for remote interaction – particularly important in today’s COVID era.
Barriers to tech adoption
Yet, despite the many advantages of technology, there is often a lack of true understanding of how it fits within the clinical pathway, with factors such as scalability, accessibility, cost – for therapist, patients and providers – and the fact a lot of tech does not allow for truly independent home use, all being potential barriers to adoption.
Developing technology without considering delivery and adoption hinders the hospital to home transition for people undergoing rehab, making it less likely to ‘stick’ and give them the agency they need to enable them to reach their goals as independently as possible.
Crucially, in order to succeed in supporting rehab and drive impact and adoption, tech should aim to be highly accessible, able to be used independently without the barriers of high cost, complexity and supervision, and have mass adoption potential.
The rehab device spectrum
Through exploration of the various rehab tools in use and weighing up their pros and cons, it is clear that cost and complexity does not necessarily imply impact. Indeed, it seems that the tech focused on accessibility, simplicity and delivery has the ability to bring the most long-term benefits to the largest number of patients.
The vast array of rehab devices includes conventional tools such as foams and putty, mobile touchscreen apps, sensor-based mobile systems, motion capture and virtual reality (VR) technologies, sensorised workstations and robots and exoskeletons. Of course, these tools aren’t accessible to everyone, with some robots and exoskeletons costing up to £1m, only facilitated by a specialist hospital or clinic environment (and not at home) and highly complex to set up and use.
Whilst motion capture and VR offer the ability to combine a lot of different types of movement in one system, including functional tasks, they are also complex in the sense that they require a level of computer literacy and may not be specifically tailored to rehab needs, with cognitive impairments of patients often being a consideration.
Mobile and sensor-based systems can be more accessible in terms of cost and patient reach, with advantages including the ability for the user to use them at home and to work on distal and finer motor control, but they do not provide active assistance, can be limited in the number of movements available to users, as well as in sensitivity and wide condition applicability, and can present challenges for home distribution.
Apps are perhaps the most accessible to the patient population with minimal cost involved and the potential to access and support millions of users. Though rehab apps can assist with finer motor control, the fact they are touch screen means there is limited range of movement, no proximal movement training ability and no strength assessment for users or their therapists to track.
Developing GripAble
GripAble is a smart mobile assessment and training device that connects to an app, to help people to work on their hand and arm movement and grip strength. Unique in the way it provides people of all ages, and their therapists, the ability and transparency to track and assess activity, GripAble is handheld and connects to a mobile app to play games to train core hand and arm movements. The results are measurable both for home-based users – and as a handy assessment tool for healthcare professionals.
Over 700 GripAble devices have been deployed since July 2020 with 3000 unique users added onto the system. But this has involved several years of development and testing of the GripAble prototype in partnership with thousands of occupational and physical therapists and patients across multiple clinical conditions, twelve different countries and leading academic institutions including Imperial College London and within Imperial Healthcare NHS Trust.
The initial feasibility studies for GripAble were driven by the idea of accessibility to ensure that the majority of patients could interact with it, including those with cognitive difficulties, when compared with other systems, and that the transition from bench to bedside was as smooth as possible. Through one study, we showed that 93 percent of patients with upper limb disability were able to interact and track their progress with GripAble. * The social aspect of GripAble was also key to engaging patients in their therapy, with collaborative training using a GripAble resulting in a 40 percent increase in engagement in rehab** whilst ensuring patients weren’t losing the human aspect that technology sometimes removes.
Innovating for the future
Alongside putting the fun into rehab, GripAble was developed with remote rehab at its heart, and can be delivered within 24 hours, with full set-up and support delivered remotely. For home-based rehab, it offers the added advantage of allowing people to train and track hand movements and grip strength from the comfort of their own home, so they can still achieve their rehab goals despite restrictions such as lockdown, and therapists can still support and help people who are shielding or self-isolating.
GripAble has the unique opportunity to be used by every single person coming into contact with the healthcare system globally, measuring and recording strength from early childhood until end-of-life care, giving us the ability to not only change the face of physical rehabilitation, but also of healthcare in general.
References
*Democratizing Neurorehabilitation: How Accessible are Low-Cost Mobile-Gaming Technologies for Self-Rehabilitation of Arm Disability in Stroke? https://pubmed.ncbi.nlm.nih.gov/27706248/
**Balancing the playing field: collaborative gaming for physical training: https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-017-0319-x
