A Low-Cost System Using a Big-Data Deep-Learning Framework for Assessing Physical Telerehabilitation: A Proof-of-Concept.

The consolidation of telerehabilitation for the treatment of many diseases over the last decades is a consequence of its cost-effective results and its ability to offer access to rehabilitation in remote areas. Telerehabilitation operates over a distance, so vulnerable patients are never exposed to unnecessary risks. Despite its low cost, the need for a professional to assess therapeutic exercises and proper corporal movements online should also be mentioned. The focus of this paper is on a telerehabilitation system for patients suffering from Parkinson's disease in remote villages and other less accessible locations. A full-stack is presented using big data frameworks that facilitate communication between the patient and the occupational therapist, the recording of each session, and real-time skeleton identification using artificial intelligence techniques. Big data technologies are used to process the numerous videos that are generated during the course of treating simultaneous patients. Moreover, the skeleton of each patient can be estimated using deep neural networks for automated evaluation of corporal exercises, which is of immense help to the therapists in charge of the treatment programs.

Assistive Devices for Personal Mobility in Parkinson's Disease: A Systematic Review of the Literature.

Background: Gait abnormalities are a hallmark of Parkinson's disease and contribute to falling risk. As disease symptoms progress, assistive devices are often prescribed. However, there are no guidelines for choosing appropriate ambulatory devices for gait impairment. Objective: To review the scientific evidence on assistive devices for gait impairment in Parkinson's disease. Methods: We performed a systematic literature review for articles relating to parkinsonian gait impairment and assistive devices. We assessed the studies' methodological quality and risk of bias using the PEDro scale. Results: Seventeen articles were reviewed. Four articles (23.53%) showed that canes and standard and two-wheeled walkers without visual cues decreased gait speed and stride length, with no significant effects on freezing of gait or falls. Instead, improvements were observed with the use of visual [seven articles (41.18%)] and auditory cues [three articles (17.65%)], including decreased number of freezing episodes and increased stride length. Conclusions: Although assistive devices seem to improve confidence, there is still limited information about the efficacy of assistive devices on gait parameters and functional disability in Parkinson's disease. Further, longitudinal, multicenter, randomized, blinded, and controlled studies using assistive devices in a free-living context are required to provide the best scientific evidence.

[Impact of rural or urban areas on disability after a stroke]. / Estudio del impacto del medio rural o urbano sobre la discapacidad residual tras un ictus.

OBJECTIVES: To assess the residual disability in a sample of patients after suffering a first episode of a stroke and to compare the disability of those patients who live in rural areas with those living in urban areas. METHODOLOGY: An observational, longitudinal study of a cohort of 89 patients from a Neurology Unit, affected by cerebrovascular accident. The following factors were assessed: sociodemographic and environmental factors, co-morbidity, functional status, disability, depression and anxiety, and quality of life. The different clinical and demographic variables were compared after admission to the unit, at hospital discharge, and 3 months afterwards. Regression analyses were also carried out in order to study the association between the clinical and sociodemographic factors, and post-stroke disability. RESULTS: Compared to their previous clinical state, after suffering a stroke patients showed a higher rate of co-morbidity (P<.0001), disability (P<.0001), depression (P=.002), and a poorer quality of life (P=.013). The difference between patients coming from rural and urban areas was not statistically significant in terms of disability, quality of life, anxiety, depression, or co-morbidity. CONCLUSIONS: The level of disability, depression and co-morbidity that patients showed after suffering a stroke was similar to the results obtained in other studies. As a novel feature, there were no differences between patients living in rural areas after suffering a stroke and those living in urban areas, as regards disability, depression, or co-morbidity.