College of Allied Health Sciences (C.A.C., S.M.H.), School of Computer and Cyber Sciences (P.T.Y.), and Hull College of Business (C.P.S.), Augusta University, Augusta, Georgia.
J Neurol Phys Ther. 2018 Jan;42(1):22-29. doi: 10.1097/NPT.0000000000000209.
This case addresses feasibility of a home-based telehealth system to enhance home exercise program (HEP) adherence for a patient with Parkinson disease (PD). We describe START-System for Technology-Augmented Rehabilitation and Training-and discuss outcomes after integrating START into the HEP component of an established therapy protocol, Lee Silverman Voice Technique BIG (LSVT BIG).
The participant was a 67-year-old woman with PD at Hoehn and Yahr Stage II.
During the first 4 weeks of a 4-month intervention, a physical therapist guided the participant through the LSVT BIG protocol. START was introduced at week 3; the participant was encouraged to complement her daily HEP through the end of the fourth month with START.
Improvements in gait, endurance, balance confidence, and quality of life were observed from the start of the assessment to the end of month 1. By month 4, the participant maintained or improved with respect to these outcomes. Monitored by START, the rate of adherence to her twice-daily HEP prescription was 24%, but her daily participation rate was 78%. The participant's satisfaction with the START system was high, although autonomous feedback provided by START was a limiting concern. There were no technical issues or adverse events reported.
This case supports START as a feasible HEP telehealth solution for physical therapy, given that increased long-term exercise adherence may improve health outcomes for people with PD. The outcomes of this case study support further investigation into the use of START for people with PD.Video Abstract available for more insights from the authors (see Video; Supplemental Digital Content 1, http://links.lww.com/JNPT/A192).
本案例探讨了基于家庭的远程医疗系统在增强帕金森病（PD）患者家庭运动计划（HEP）依从性方面的可行性。我们描述了 START 系统（用于技术增强康复和训练的系统），并讨论了在将 START 整合到既定治疗方案（LSVT BIG）的 HEP 部分后取得的结果。
患者为一名 67 岁的 PD 女性，处于 Hoehn 和 Yahr 分期 II 期。
在为期 4 个月的干预计划的前 4 周，物理治疗师指导患者完成 LSVT BIG 方案。第 3 周开始引入 START；鼓励患者在第四个月末继续通过 START 来补充日常 HEP。
从评估开始到第 1 个月结束，患者的步态、耐力、平衡信心和生活质量都有所改善。到第 4 个月，患者在这些结果上保持或改善。通过 START 监测，她每天坚持两次 HEP 处方的依从率为 24%，但每天的参与率为 78%。尽管 START 提供的自主反馈是一个限制因素，但患者对 START 系统的满意度很高。未报告技术问题或不良事件。
鉴于增加长期运动依从性可能改善 PD 患者的健康结果，本案例支持 START 作为一种可行的 HEP 远程医疗解决方案。本案例研究的结果支持进一步研究 START 在 PD 患者中的应用。（作者观点详见视频；补充数字内容 1，http://links.lww.com/JNPT/A192）。
