Tele-Neurorehabilitation During the COVID-19 Pandemic: Implications for Practice in Low- and Middle-Income Countries.

The importance of neurorehabilitation services for people with disabilities is getting well-recognized in low- and middle-income countries (LMICs) recently. However, accessibility to the same has remained the most significant challenge, in these contexts. This is especially because of the non-availability of trained specialists and the availability of neurorehabilitation centers only in urban cities owned predominantly by private healthcare organizations. In the current COVID-19 pandemic, the members of the Task Force for research at the Indian Federation of Neurorehabilitation (IFNR) reviewed the context for tele-neurorehabilitation (TNR) and have provided the contemporary implications for practicing TNR during COVID-19 for people with neurological disabilities (PWNDs) in LMICs. Neurorehabilitation is a science that is driven by rigorous research-based evidence. The current pandemic implies the need for systematically developed TNR interventions that is evaluated for its feasibility and acceptability and that is informed by available evidence from LMICs. Given the lack of organized systems in place for the provision of neurorehabilitation services in general, there needs to be sufficient budgetary allocations and a sector-wide approach to developing policies and systems for the provision of TNR services for PWNDs. The pandemic situation provides an opportunity to optimize the technological innovations in health and scale up these innovations to meet the growing burden of neurological disability in LMICs. Thus, this immense opportunity must be tapped to build capacity for safe and effective TNR services provision for PWNDs in these settings.

Multi-Lateral Teleoperation Based on Multi-Agent Framework: Application to Simultaneous Training and Therapy in Telerehabilitation.

In this paper, a new scheme for multi-lateral remote rehabilitation is proposed. There exist one therapist, one patient, and several trainees, who are participating in the process of telerehabilitation (TR) in this scheme. This kind of strategy helps the therapist to facilitate the neurorehabilitation remotely. Thus, the patients can stay in their homes, resulting in safer and less expensive costs. Meanwhile, several trainees in medical education centers can be trained by participating partially in the rehabilitation process. The trainees participate in a "hands-on" manner; so, they feel like they are rehabilitating the patient directly. For implementing such a scheme, a novel theoretical method is proposed using the power of multi-agent systems (MAS) theory into the multi-lateral teleoperation, based on the self-intelligence in the MAS. In the previous related works, changing the number of participants in the multi-lateral teleoperation tasks required redesigning the controllers; while, in this paper using both of the decentralized control and the self-intelligence of the MAS, avoids the need for redesigning the controller in the proposed structure. Moreover, in this research, uncertainties in the operators' dynamics, as well as time-varying delays in the communication channels, are taken into account. It is shown that the proposed structure has two tuning matrices (L and D) that can be used for different scenarios of multi-lateral teleoperation. By choosing proper tuning matrices, many related works about the multi-lateral teleoperation/telerehabilitation process can be implemented. In the final section of the paper, several scenarios were introduced to achieve "Simultaneous Training and Therapy" in TR and are implemented with the proposed structure. The results confirmed the stability and performance of the proposed framework.

[Design and Trial Operation of Tele-rehabilitation Gradient Motor Function Self-evaluating System for Stroke Patients].

In order to overcome the defects of the motor function evaluation systems contained in current tele-rehabilitation devices, such as inconvenient, incomplete of measurement position, nonstandard and lacking of humanized design, we designed and developed a tele-rehabilitation gradient motor function self-evaluating system in this paper. Based on Brunnstrom stage, this system which was competitive comparing to manual evaluations, common tele-rehabilitation assessments and similar nonmedical products, realized the quantitative motor assessment for both limbs of stroke patients using the self-developed algorithms. The clinical trials proved that the system was feasible and accurate.

Design and Trial Operation of Tele-rehabilitation Gradient Motor Function Self-evaluating System for Stroke Patients / 中国医疗器械杂志

In order to overcome the defects of the motor function evaluation systems contained in current tele-rehabilitation devices, such as inconvenient, incomplete of measurement position, nonstandard and lacking of humanized design, we designed and developed a tele-rehabilitation gradient motor function self-evaluating system in this paper. Based on Brunnstrom stage, this system which was competitive comparing to manual evaluations, common tele-rehabilitation assessments and similar nonmedical products, realized the quantitative motor assessment for both limbs of stroke patients using the self-developed algorithms. The clinical trials proved that the system was feasible and accurate.