Insights on Telecommunication Use by Rehabilitation Therapists Before, During, and Beyond COVID-19.

Objective: To determine if the use of telerehabilitation among rehabilitation therapists during the first 11 months of the COVID-19 pandemic increased, if therapists' identified plans to continue use after the pandemic, and to understand challenges that therapists face in using telerehabilitation, and to evaluate viable use-cases for telerehabilitation. Design: A survey was conducted among clinicians containing questions about tools being used before, during, and after (planned) COVID-19. Statistical analysis was conducted to evaluate the increase in actual usage of telerehabilitation during the pandemic and planned usage after the pandemic. Setting: The study was survey-based and conducted remotely via online distribution. Participants: 387 participants (90.2% women) with an average age of 40.1 years participated in the survey and satisfied selection criteria. On average, they practiced for 14.8 years. Main Outcome Measures: No interventions were made. Survey item results were used for analysis. Results: Therapists used telerehabilitation more frequently during COVID-19 as compared with before COVID-19. Therapist use of video calls more than tripled (288.89% increase) during COVID-19. Speech therapists were far more likely to adopt telerehabilitation than physical therapists or occupational therapists. 18.9% of therapists planned to use video-based remote communication with patients after COVID-19. 31% of therapists who had not previously used telerehabilitation prior to the pandemic anticipated using it post-pandemic. Most therapists (88%) believed that discussion-based activities could be done remotely. Conclusions: COVID-19 has affected the way therapists interact with patients. These changes may have lasting effect on patient interactions and a perceived potential for future use of telerehabilitation is evident. Therapists who had already made use of remote communication had more optimistic outlooks on the future utility of these mediums, indicating that exposure favors future use. Therapists anticipate a potential increase in utilization of Video-Based Telerehabilitation post-pandemic but have faced and expect to face challenges in use of telerehabilitation. While disparities and obstacles to access pose challenges, the progress made during COVID-19 is promising.

Feasibility and Acceptability of Remote Neuromotor Rehabilitation Interactions Using Social Robot Augmented Telepresence: A Case Study.

There is a growing need to deliver rehabilitation care to patients remotely. Long term demographic changes, geographic shortages of care providers, and now a global pandemic contribute to this need. Telepresence provides an option for delivering this care. However, telepresence using video and audio alone does not provide an interaction of the same quality as in-person. To bridge this gap, we propose the use of social robot augmented telepresence (SRAT). We have constructed a demonstration SRAT system for upper extremity rehab, in which a humanoid, with a head, body, face, and arms, is attached to a mobile telepresence system, to collaborate with the patient and clinicians as an independent social entity. The humanoid can play games with the patient and demonstrate activities. These activities could be used to perform assessments in support of self-directed rehab and to perform exercises.In this paper, we present a case series with six subjects who completed interactions with the robot, three subjects who have previously suffered a stroke and three pediatric subjects who are typically developing. Subjects performed a Simon Says activity and a target touch activity in person, using classical telepresence (CT), and using SRAT. Subjects were able to effectively work with the social robot guiding interactions and 5 of 6 rated SRAT better than CT. This study demonstrates the feasibility of SRAT and some of its benefits.

The design of Lil'Flo, a socially assistive robot for upper extremity motor assessment and rehabilitation in the community via telepresence.

INTRODUCTION: We present Lil'Flo, a socially assistive robotic telerehabilitation system for deployment in the community. As shortages in rehabilitation professionals increase, especially in rural areas, there is a growing need to deliver care in the communities where patients live, work, learn, and play. Traditional telepresence, while useful, fails to deliver the rich interactions and data needed for motor rehabilitation and assessment. METHODS: We designed Lil'Flo, targeted towards pediatric patients with cerebral palsy and brachial plexus injuries using results from prior usability studies. The system combines traditional telepresence and computer vision with a humanoid, who can play games with patients and guide them in a present and engaging way under the supervision of a remote clinician. We surveyed 13 rehabilitation clinicians in a virtual usability test to evaluate the system. RESULTS: The system is more portable, extensible, and cheaper than our prior iteration, with an expressive humanoid. The virtual usability testing shows that clinicians believe Lil'Flo could be deployed in rural and elder care facilities and is more capable of remote stretching, strength building, and motor assessments than traditional video only telepresence. CONCLUSIONS: Lil'Flo represents a novel approach to delivering rehabilitation care in the community while maintaining the clinician-patient connection.

Perceived Usefulness of a Social Robot Augmented Telehealth Platform by Therapists in the United States.

With the shortage of rehabilitation clinicians in rural areas and the ongoing COVID-19 pandemic, remote rehabilitation (telerehab) fills an important gap in access to rehabilitation, especially for the treatment of adults and children experiencing upper arm disability due to stroke and cerebral palsy. We propose the use of a socially assistive robot with arms, a torso, and a face to play games with and guide patients, coupled with a telepresence platform, to maintain the patient-clinician interaction, and a computer vision system, to aid in automated objective assessments, as a tool for achieving more effective telerehab. In this paper, we outline the design of such a system, Lil'Flo, and present a uniquely large perceived usefulness evaluation of the Lil'Flo platform with 351 practicing therapists in the United States. We analyzed responses to the question of general interest and 5 questions on Lil'Flo's perceived usefulness. Therapists believe that Lil'Flo would significantly improve communication, motivation, and compliance during telerehab interactions when compared to traditional telepresence. 27% of therapists reported that they were interested in using Lil'Flo. Therapists interested in using Lil'Flo perceived it as having significantly higher usefulness across all measured dimensions than those who were not interested in using it.

Designing and Evaluating the Face of Lil'Flo: an Affordable Social Rehabilitation Robot.

We introduce Lil'Flo, an affordable robot for pediatric upper extremity rehabilitation. We present the design and fabrication methodology of the head and face of the robot, the central design element for emotional expression. Through a guided interview with 10 subjects, a number of faces which have a clear sentiment associated with them are identified. The data suggest that a digital face, characterized by eyes and a mouth, can express sadness, happiness, surprise, and mischievousness well, but that finer emotions, e.g., differentiating between happy and very happy can be difficult. The data fail to show that a robot with a dynamic face is viewed more positively than one with a static face. The results of numerical sentiment analysis and open ended questions provide a design direction for our face and a general idea of simple face designs which have a clear sentiment.