Gvion Aviah, Shahaf Goded
Reuth Rehabilitation Center, Tel-Aviv, Israel.
Ono Academic College, Kiryat Ono, Israel.
Disabil Rehabil Assist Technol. 2021 May 25:1-13. doi: 10.1080/17483107.2021.1929513.
There is ample evidence that patient engagement is of major clinical importance in rehabilitation, and it seems this engagement is based upon effective allocation of attention to the tasks during the rehabilitation session. It is possible to discern two types of barriers which hinder attentive engagement: (1) dysfunctional affective coping and (2) limited cognitive recruitment and specifically attention deficit. These barriers might be general for a given patient, due to pre-morbid or co-morbid dysfunctions. But more often they are evoked by tasks or challenges during the rehabilitation session which might be too complicated or stressing for the specific patient who copes with potentially grave impairments. These barriers hinder rehabilitation progress and should be monitored and overcome, by the therapist, throughout the session.
We have developed an easy-to-use tool for monitoring a patient's attentive engagement in real-time throughout a rehabilitation session based on analysing the electrophysiological signal sampled from a simple headset. The tool then analyzes the dynamics of the marker over time to identify cognitive and affective barriers during the session. It enables the therapist to insert feedback regarding the patient's functional performance and to combine it with the analysed barriers, in order to derive automatic recommendations for overcoming the cognitive and affective barriers (if identified) for significant enhancement of the rehabilitation session.
In this work we present the principles of the tool as well as three detailed case reports to demonstrate its potential usefulness.IMPLICATIONS FOR REHABILITATIONCognitive and affective barriers hinder patient engagment and rehabilitation success.In this work we present an easy to use electrophysiology-based tool which monitors these barriers.Based on the measured barriers and patient's performance, the tool derives treatment suggestions.
有充分证据表明患者参与在康复中具有重要的临床意义，而且这种参与似乎基于在康复过程中对任务有效地分配注意力。可以识别出两种阻碍专注参与的障碍：（1）功能失调的情感应对方式，以及（2）有限的认知资源调动，特别是注意力缺陷。这些障碍对于特定患者可能是普遍存在的，这是由于病前或共病功能障碍所致。但更常见的情况是，它们是由康复过程中的任务或挑战引发的，对于应对潜在严重损伤的特定患者来说，这些任务或挑战可能过于复杂或压力过大。这些障碍会阻碍康复进程，治疗师在整个疗程中都应加以监测和克服。
我们开发了一种易于使用的工具，通过分析从一个简单头戴式设备采集的电生理信号，在整个康复疗程中实时监测患者的专注参与度。该工具随后分析标记随时间的动态变化，以识别疗程中的认知和情感障碍。它使治疗师能够插入有关患者功能表现的反馈，并将其与分析出的障碍相结合，以便得出克服认知和情感障碍（如果识别出）的自动建议，从而显著增强康复疗程效果。
在这项工作中，我们介绍了该工具的原理以及三个详细的病例报告，以证明其潜在的实用性。
对康复的启示
认知和情感障碍会阻碍患者参与及康复成功。在这项工作中，我们展示了一种易于使用的基于电生理学的工具，该工具可监测这些障碍。基于所测得的障碍和患者的表现，该工具可得出治疗建议。
