As the population ages, there is an increasing need to move health care provision from hospitals to primary and home care. Indeed, this shift, particularly important in the care of chronic diseases, is a priority in Europe.
Changing the provision of healthcare in this way not only saves costs, and relieves pressure on hospital services, but also has the potential to offer better quality and more personalised care. It is also generally preferred by patients.
However, in order to bring care closer to patients’ homes we must solve a number of problems. Adequate monitoring and treatment tools are required to make it easier for patients to manage their condition. Also, adequate tools and infrastructure for specialist professionals and/or general practitioners to supervise and support patients and their caregivers throughout the process.
A clear case in which this transformation is indispensable is stroke. The Health Plan for the Basque Country 2013-2020 includes among its objectives a “personalised early and home stroke rehabilitation plan”. This condition also has an advantage over other chronic illnesses: there is a chance of recovery.
Stroke is one of the main causes of permanent disability among adults along with heart disease and lumbago/cervicalgia. According to the report made by the Spanish Federation of Cerebral Damage in 2015 lived in the Spanish state about 420,000 people with the after-effects of a stroke.
Each year 104,701 new cases are registered. In Europe, stroke has an incidence of 1.1 million people and a prevalence of 6 million. A 34% increase is expected between 2015 and 2035 (The burden of Stroke in Europe, 2017).
Stroke is a sudden disorder of the cerebral circulation, which alters the function of the region of the brain presenting the injury. This episode causes a sudden loss of brain capacity, whose consequences in survivors can affect motor, sensory, perceptual and / or cognitive functions, or combinations that can be very varied depending on which area is affected.
One of the most common consequences of a stroke, in 75% of cases, is hemiparesis of the upper limb: it prevents daily tasks such as using a knife and fork, brushing teeth or buttoning.
After a stroke, patients usually follow a rehabilitation process, which is one of the most important parts of their treatment. However, at present, 40-45% of stroke survivors are unable to perform daily tasks such as eating or grooming after conventional rehabilitation, with the consequent loss of autonomy and quality of life and burden on their carers (Ministry of Health and Social Policy, 2009).
It is estimated that the average cost of treating a patient is around 25,000 euros, which, added to the costs of the resulting dependency of patients with disabilities, represents an expenditure of more than 45,000 million euros per year in Europe.
We are therefore faced with two main needs:
- Increasing the effectiveness of treatment and the success rate of rehabilitation
- Reduce your cost
According to the scientific evidence, most patients can improve if they receive an adequate therapy, which has four main requirements: an adequate dose and intensity, as soon as possible, adapted to the patient and maintaining the patient’s motivation (Kwakkel, 2004; Ward, 2015).
However, the growing number of affected population and limited health resources make it difficult to provide intensive rehabilitation care through traditional approaches.
Solutions are needed that allow more patients to be treated more effectively and with fewer but more efficient resources, that support the work of the specialist and allow him or her to treat several patients at once, but also replace him or her in primary care centres and at home, allowing rehabilitation to continue once the patient is sent home.
Along these lines, we are researching new solutions that allow rehabilitation to be as autonomous, effective and reliable as possible; attributes that, together with cost and ease of use, are indispensable for introducing advanced technologies for rehabilitation (ART) in the home.
Robotics for rehabilitation is a key field of research. Robots offer precision and repeatability of movements that can be used to provide intensive, safe rehabilitation exercises in an unsupervised environment.
Combined with serious games, which provide a fun and effective way to motivate patients to train more intensively for longer; and with telecare platforms, which offer therapists the ability to monitor adherence to treatment; they are ideal tools for continuing rehabilitation at home.
Another fundamental line of research in this area is assessment tools. The automatic evaluation of the patient’s condition is key for a training without partial or total supervision, to allow the remote monitoring of the patient’s progress by the therapist and the automatic and/or manual adaptation of the training.
These tools can also be used to monitor and promote the transfer of rehabilitation results to functional capacity in the patient’s daily life, thus ensuring a real impact on the patient’s quality of life and independence.
The combination of these technologies allows to create solutions capable of providing a daily, intensive and adapted rehabilitation to the patient at home for as long as necessary, something hardly possible in rehabilitation centers.
Clinical partners in the Basque Country and Andalusia estimate that 25% of the savings that this type of solution can represent for a rehabilitation service in terms of specialist time, hospitalisation time, ambulance trips, etc., thus increasing the rehabilitation time for each patient and the number of patients to be attended to.
In addition, this type of technology represents an opportunity for the industrial fabric in the promising sector of neurorehabilitation. Specifically, in the specific segment of “Therapeutic Neurorobotic Systems” it is estimated at 102 million dollars in 2017, with an average annual growth of around 16% until 2020 (World market of technology for Neurorehabilitation 2016-2020, Neurotech Reports).
On the one hand, they represent new business opportunities for companies that already offer products and components for the health, medical device and rehabilitation sectors.
On the other hand, for entities from other more traditional sectors such as electronics, mechatronics or information technologies, it represents an opportunity to expand their product portfolio and access new markets.
Today we are witnessing a “boom” of devices, applications, programs and utilities that unite new technologies and intervention in dementias or specifically in Alzheimer’s disease.
The use and proliferation of these means cannot be criticized; on the contrary, through new technologies, a greater number of people can have access to very diverse resources (information, training, consultation, entertainment, therapy, etc.).
and which would otherwise be difficult to obtain. A clear example in Alzheimer’s disease would be, for example, individuals and families who in the rural world do not have a nearby AFA support service and the social and health resources available in their context are not sufficient.
In the first place, terms to which the objectives of these programmes refer should really be delimited, and these terms would be “cognitive stimulation”, “cognitive training”, “cognitive rehabilitation” and “neuropsychological rehabilitation”.