Dr Clare Walton, Research Communications Officer at The Stroke Association
Stroke is the leading cause of complex adult disability in the UK. As our population continues to age, the number of people living with stroke will rise, placing increasing demand on our health and social care systems to support their rehabilitation. Digital solutions are already reaching the market but the need for innovation is greater than ever before.
If you imagine a typical stroke survivor, you are unlikely to describe them as “tech-savvy”. The stereotypical view is someone in their 80s, perhaps living in a nursing home, and probably someone not interested in new technologies.
Yes it is true that the incidence of stroke increases dramatically with age, but this stereotype does not fit with today’s reality. Older people are becoming increasingly confident with computers and gadgets, and are turning to them for healthcare support.
Technological innovation is developing at an extraordinary rate, and becoming cheaper, more accessible and more widely available. There are already several products and online tools available to help stroke survivors adapt to some of the common effects of stroke, with many more innovative solutions in development.
Free therapy via the internet
One in five stroke survivors suffer from a loss of peripheral vision, making it difficult to read or to locate objects around them. With funding from the Stroke Association, researchers at UCL have developed two free online therapy tools to train the brains of stroke patients to adapt to the loss of vision.
With just 20 hours of practice using the ReadRight webtool, stroke survivors can improve their reading speed by 50{cf2c27d335602139ec9071daca508545599ba8f9ca09b366fd00e5c28736f208}, giving them enough confidence to return to work. With more than 40{cf2c27d335602139ec9071daca508545599ba8f9ca09b366fd00e5c28736f208} of pensioners now using the internet at home, self-directed therapy websites like these could become an important part of someone’s stroke recovery.
Rehabilitation gaming makes physio fun
Weakness along one side of the body is very common after a stroke, with 70{cf2c27d335602139ec9071daca508545599ba8f9ca09b366fd00e5c28736f208} of stroke survivors experiencing impaired arm movement. Recovery is possible with intense physiotherapy. But with only 45 minutes of therapist time each week, it can be a challenge for patients to keep up with the repetitive practice alone.
One solution is rehabilitation gaming. Motion-controlled consoles such as the Nintendo Wii and more recently the Xbox Kinect are fitted with games to motivate independent physiotherapy practice at home. The Able-X system (pictured) comes with an adapted handset so that patients with more severe paralysis can use their normal arm to help coordinate movements of the affected side. The latest in physio gaming is new software from Roke that enables Kinect to track the movements of individual fingers, supporting the rehabilitation of finer hand movements after stroke.
Robotic physiotherapy aids are also showing promise in stroke; they control limb movement to make sure patients are practicing safe and correct movements. However, the sheer expense of robotic equipment has been a significant barrier to bringing these products to the commercial market.
Building confidence with virtual reality conversations
One in three stroke survivors experience a condition called aphasia, which limits their ability to communicate due to damage to the language centres in the brain. Computer software for aphasia has been around a while. Although these games can help patients to practice naming words and understanding sentences, they don’t really help them to practice holding conversations in real-life situations.
The Stroke Association is currently funding Professor Jane Marshall at City University London to develop a virtual reality environment that will allow aphasia patients to interact with speech therapists and each other using online avatars. This safe online space will encourage stroke survivors to practice holding conversations in a realistic environment, reducing feelings of social isolation and giving them confidence to communicate out in the real world.
Making tea with computer supervision
One of the more advanced tech projects for cognitive rehabilitation after stroke is CogWatch. The team are developing a behaviour tracking system that will assist patients who struggle with everyday activities due to disorders of motor planning like apraxia. The system uses intelligent everyday objects like a mug or kettle and the Kinect motion tracker to monitor the patient as they perform a task, such as making a cup of tea. It will use behaviour prediction algorithms to detect when the stroke survivor makes an error and will prompt them to correct their mistake.
Occupational therapists currently use these methods of error correcting and prompting to rehabilitate apraxia after stroke. The CogWatch system could do what rehabilitation gaming has done for physical therapy: it could allow patients to do extra therapy practice in their own homes without the need for a therapist to be present. And as we know with all tasks, whether learning them for the first time or re-learning them after a stroke, practice makes perfect!
You may be wondering, is this just a really high-tech way of helping someone to make a cup of tea? But don’t underestimate how important it is to a stroke survivor to be able to perform these familiar activities without the help or supervision of a carer. CogWatch intends to target other important daily tasks such as preparing food, dressing and grooming. If the system can help a person recover independence in these activities then it will go a long way to improving quality of life for the stroke survivor and their family members.