Simon Brière

Effectiveness of cervical spine stabilization techniques.

Objective:To compare head motions that occur when trained professionals perform the head squeeze (HS) and trap squeeze (TS) C-spine stabilization techniques. Design:Cross-over design. Participants:Twelve experienced lead rescuers. Main Outcome Measures:Peak head motion with respect to initial conditions using inertial measurement units attached to the forehead and trunk of the simulated patient. We compared both HS and TS during lift-and-slide (L&S) and log-roll (LR) placement on spinal board, and agitated patient trying to sit up (AGIT-Sit) or rotate his head (AGIT-Rot). The a priori minimal important difference (MID) was 5 degrees for flexion or extension and 3 degrees for rotation or lateral flexion. Results:The L&S technique was statistically superior to the LR technique. The only differences to exceed the MID were extension and rotation during LR (HS > TS). In the AGIT-Sit test scenario, differences in motion exceeded MID (HS > TS) for flexion, rotation, and lateral flexion. In the AGIT-Rot scenario, differences in motion exceeded MID for rotation only (HS >TS). There was similar intertrial variability of motion for HS and TS during L&S and LR but significantly more variability with HS compared with TS in the agitated patient. Conclusions:The L&S is preferable to the LR when possible for minimizing unwanted C-spine motion. There is little overall difference between HS and TS in a cooperative patient. When a patient is confused, the HS is much worse than the TS at minimizing C-spine motion.

Simulated in-home teletreatment for anomia

This pilot study explored the feasibility of in-home teletreatment for patients with post-stroke anomia. Three participants over 65 years of age suffering from post-stroke anomia were treated in this pre/post-intervention case study. They received 12 speech therapy teletreatments (two sessions/week for 6 weeks) aimed at improving confrontation naming skills. Half of the failed items from a set of 120 preselected stimuli were trained during treatment (Block A-trained stimuli) while the other half served as controls (Block B-untrained stimuli). Variables measured were: 1) efficacy of treatment (performance on Block-A vs. Block B Stimuli), and 2) participants’ satisfaction with teletreatment (using a French adaptation of the Telemedicine satisfaction questionnaire). All participants showed a clinically relevant improvement on confrontation naming of trained items and less improvement for untrained items. The researchers also obtained high satisfaction scores on the questionnaire (above 57/60). This pilot study supports the feasibility of speech therapy teletreatments applied to neurological language disorders.

Wireless inertial measurement unit with GPS (WIMU-GPS) — Wearable monitoring platform for ecological assessment of lifespace and mobility in aging and disease

This paper proposes an innovative ambulatory mobility and activity monitoring approach based on a wearable datalogging platform that combines inertial sensing with GPS tracking to assess the lifespace and mobility profile of individuals in their home and community environments. The components, I/O architecture, sensors and functions of the WIMU-GPS are presented. Outcome variables that can be measured with it are described and illustrated. Data on the power usage, operating autonomy of the WIMU-GPS and the GPS tracking performances and time to first fix of the unit are presented. The study of lifespace and mobility with the WIMU-GPS can potentially provide unique insights into intrapersonal and environmental factors contributing to mobility restriction. On-going studies are underway to establish the validity and reliability of the WIMU-GPS in characterizing the lifespace and mobility profile of older adults.

Contact-Free Respiration Rate Monitoring Using a Pan–Tilt Thermal Camera for Stationary Bike Telerehabilitation Sessions

One typical remote consultation envisioned for in-home telerehabilitation involves having the patient exercise on a stationary bike. Making sure that the patient is breathing well while pedaling is of primary concern for the remote clinician. One key requirement for in-home telerehabilitation is to make the system as simple as possible for the patients, avoiding, for instance, to have them wear sensors and devices. This paper presents a contact-free respiration rate monitoring system measuring temperature variations between inspired and expired air in the mouth-nose region using thermal imaging. The thermal camera is installed on a pan-tilt unit and coupled to a tracking algorithm, allowing the system to keep track of the mouth-nose region as the patient exercises. Results demonstrate that the system works in real time even when the patient moves or rotates its head while exercising. Recommendations are also made to minimize limitations of the system, such as the presence of people in the background or when the patient is talking, for its eventual use in in-home telerehabilitation sessions.

In-home telehealth clinical interaction using a robot

Providing healthcare in remote locations can prove to be costly. Using a static videoconference system in the patients home has its limitations. A remotely operated mobile robot platform could provide a better interaction with the patient located at home. This paper presents Telerobot, a teleoperated mobile robotic platform equipped with videoconferencing capabilities. Developed by a team of roboticists and clinical experts, the system is designed specifically for the provision of in-home telerehabilitation services. A usability study was done in order to qualify the robot user control scheme and the clinician-patient interaction.

Embedded auditory system for small mobile robots

Auditory capabilities would allow small robots interacting with people to act according to vocal cues. In our recent work, we have demonstrated AUDIBLE, an auditory system capable of sound source localization, tracking and separation in real-time, using an array of eight microphones and running on a laptop computer. The system is able to localize and track up to four sources, while separating up to three sources in real-time in noisy environments. Signal processing techniques can be quite computer intensive, and the question of making it possible for this system to run on platforms that cannot carry a laptop computer onboard can be raised. This paper reports our investigation of the appropriate compromises to be made to AUDIBLEs implementation in order to port the system on an embedded DSP (Digital Signal Processor) platform. The DSP implementation is fully functional and performs well with minor limitations compared to the original system i.e., limitations on sound source duration and on the number of sources that can be processed simultaneously. Results demonstrate that it is feasible to port AUDIBLE on embedded platforms, opening up its use in field applications such as human-robot interaction in real life settings.

From teletraining to telehomecare — Design of mobile and multi-stream telehealth systems

Telehealth success relies on the ability of information and communication technologies (ICT) to maximize the quality of care provided remotely, i.e., providing diagnostics and treatments of the same quality compared to face-to-face or conventional means, and maximize the benefits for the patients, the clinicians and the system of care. Because of the specific nature of health-related processes, successful development of telehealth technologies must be driven by clinical and application needs that are not addressed by currently available ICT. In this paper, we present two telehealth systems developed in two different contexts, one for teletraining of surgical procedures, and one for telerehabilitation, and from which common requirements can be identified for the development of a more generic platform. This paper also situates where these systems are in relation to their stage of development and their assessment as telehealth technologies.

Telehomecare telecommunication framework — From remote patient monitoring to video visits and robot telepresence

Over the last few years, the number of remote patient monitoring (RPM) products and of videoconferencing systems has exploded. There is also a significant number of research initiatives addressing the use of service robots for assistance in daily living activities. From a technological standpoint, providing telehomecare services is certainly feasible. However, one technological barrier is to have access to a telecommunication platform that can be adapted to address the broad range of specifications and requirements of clinical and telehealth applications. Handling the full spectrum of possibilities requires a telecommunication framework that can transmit vital sign data from patients to clinicians, bidirectional audio-video from a standard computing device, and also multiple video streams and bidirectional transmission of control data. This paper presents a framework that integrates such capabilities. It also illustrates the versatility of the framework by presenting custom-designed devices allowing integration of capabilities ranging from RPM to video visits and robot telepresence.

Conditions of Use, Reliability, and Quality of Audio/Video-Mediated Communications During In-Home Rehabilitation Teletreatment for Postknee Arthroplasty

BACKGROUND Audio/video-mediated communication between patients and clinicians using videoconferencing over telecommunication networks is a key component of providing teletreatments in rehabilitation. OBJECTIVE The objectives of this study were to (1) document the conditions of use, performance, and reliability of videoconferencing-based communication in the context of in-home teletreatment (TELE) following total knee arthroplasty (TKA) and (2) assess from the perspective of the providers, the quality attributes of the technology used and its impact on clinical objectives. MATERIALS AND METHODS Descriptive embedded study in a randomized controlled trial using a sample of 97 post-TKA patients, who received a total of 1,431 TELE sessions. Technical support use, service delivery reliability, performance, and use of network connection were assessed using self-report data from a costing grid and automated logs captured from videoconferencing systems. Physical therapists assessed the quality and impact of video-mediated communications after each TELE session on seven attributes. RESULTS Installation of a new Internet connection was required in 75% of the participants and average technicians time to install test and uninstall technology (including travel time) was 308.4 min. The reliability of service delivery was 96.5% of planned sessions with 21% of TELE session requiring a reconnection during the session. Remote technical support was solicited in 43% of the sessions (interventions were less than 3-min duration). Perceived technological impacts on video-mediated communications were minimal with quality of the overall technical environment evaluated as good or acceptable in 96% of the sessions and clinical objectives reached almost completely or completely in 99% of the sessions. CONCLUSIONS In-home rehabilitation teletreatments can be delivered reliably but requires access to technical support for the initial setup and maintenance. Optimization of the processes of reliably connecting patients to the Internet, getting the telerehabilitation platform in the patients home, installing, configuring, and testing will be needed to generalize this approach of service delivery.

Is a decrease of grip strength associated with community mobility restriction in dynapenic older women

Absolute grip strength (aGS) measures are not only used to detect dynapenia, but can also provide a robust indicator of functional impairments such as mobility limitations. Mobility limitations can impact community mobility. The main objective of this study was to investigate whether dynapenia status measured with aGS can be used as a predictor of the level of community mobility measured by Global Positioning System (GPS) and the Life‐Space Assessment questionnaire (LSA) in healthy older adults. It has been shown that body weight related grip strength (GS/BW) is also a clinical predictor of functional limitation. The secondary objective of the study was to assess the relationship between the community mobility and the GS/BW.