CC BY
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Journal of Health Sciences (J Health Sci) 2011 Vol 1, No 3 127 - 136
Open Access
Open Journal Systems of Radom University in Radom, Poland ISSN 1429-9623 / 2011
ATTEMPTS OF INTEGRATION OF SOLUTIONS FOR DISABLED PEOPLE
Proby integracji rozwiqzan dla osob niepelnosprawnych
1 2 Emilia Mikolajewska *, Dariusz Mikolajewski
Rehabilitation Clinic, The 10th Clinical Military Hospital with Policlynic, Bydgoszcz, Poland
*E-mail: <e.mikolajewska@wp.pl>
2Department of Informatics, Nicolaus Copernicus University, Torun, Poland
© The Author(s) 2011;
This article is published with open access at Licensee Open Journal Systems of Radom University in Radom, Poland
Keywords: rehabilitation; physiotherapy; disabled people; assistive technology; integrated solutions.
Abstract
Development of medicine, increased survival rates in severe illnesses and traumatic disorders have led to an increase in the number of disabled people. Demographic tendencies in developed countries, including increased life expectancy cause need for dedicated solutions for elderly people. Limited number of specialized medical staff, limited help of families and limited amount of money to spend on have caused necessary looking for new solutions. Observed progress in technology, including IT, automation, robotics and communications shows a great deal of promise in areas of assistive technology, assisted therapy and rehabilitation. This way development of rehabilitation, physical therapy and social care joined with biomedical engineering and rehabilitation engineering can change meaning of words “disabled people ”. This article aims at
investigating the extent to which the available opportunities are being exploited, including the own concept of the disabled person’s integrated IT environment.
Introduction
Development of medicine, increased survival rates in severe illnesses and traumatic disorders have led to an increase in the number of disabled people - according to the WHO an estimated 650 million people live with disabilities around the world. Demographic tendencies in developed countries, including increased life expectancy cause need for dedicated solutions for elderly people. According to WHO 2 billion older people will be alive in 2050. It can be a big problem, especially in developed countries, where percentage of older people can achieve 50-70% of population. Limited number of specialized medical staff, limited help of families and limited amount of money to spend on have caused necessary looking for new solutions. Observed progress in technology, including IT, automation, robotics and communications shows a great deal of promise in areas of assistive technology, assisted therapy and rehabilitation. This article aims at investigating the extent to which the available opportunities are being exploited, including the own concept of the disabled person’s integrated IT environment. This way development of rehabilitation, physical therapy and social care joined with biomedical engineering and rehabilitation engineering can change meaning of words “disabled people”. There is a time of paying particular attention to their needs, independence and quality of life [1, 2, 3].
Contemporary integrated systems
Basic goal of contemporary solutions is to provide patients as more of independence as possible, but use of assistive technology is limited. Increasing their quality of life demands new solutions. One of ways to achieve it needs using synergy of: healthcare and social welfare systems,
family and carers support,
technical solutions (including the newest solutions of assistive technology, IT, automation, robotics, etc.),
safety and access control for all above mentioned systems.
Selected areas within integrated environment of disabled person:
• communication, work and learning,
• mobility,
• daily functional activities,
• home care,
• inpatient care,
• carers and medical staff support,
• clean environment policy.
Contemporary integrated systems can be developed based on:
smart home with flexible control systems and functions dedicated to disabled, severely ill and disabled people,
intelligent equipment of smart home, providing safety and independence indoor, i-wear, providing safety and independence outdoor,
Ambient Intelligence (AmI) based on Internet of Things (IoT), as next step in artificial intelligence of human environment and human-computer interaction (HCI) within Information Society [2, 4], Affective Computing (AC) as a part of AmI systems, providing easier troubleshooting, better mood and well-being of patients.
Described solutions can adapt patients’ home and other environment (e.g. community) according to requirements of patient and automate home care and rehabilitation. Selected additional systems and technologies are perceived as elements of integrated environments for disabled people:
Hospital Information System (abbr. HIS) and its functional components: Radiological Information System (abbr. RIS), Laboratory Information System (abbr. LIS), Drug Information System (abbr. DIS),
new generations of sensors, diagnostic imaging, diagnostic systems, etc., medical data bases, expert systems and data mining systems,
telemedicine and telerehabilitation systems, especially telemetry and telerehabilitation, which transfers some parts of the therapy from hospital to home of the patient,
light and durable manual wheelchairs, including cheap solutions for developing countries [5, 6], electric drives for manual wheelchairs, supporting modules for manual wheelchairs (e.g. for strair climbing - Scalamobil, for accelerating - Viamobil),
robotic and multipurpose powered wheelchairs with intelligent control systems: iBot 4000, TankChair, etc. [6],
medical exoskeletons (HAL5, ReWalk) and other wheelchair alternatives: scooters, walking assistive devices [7, 8, 9],
intelligent human-computer interfaces, based on speech recognition and multiomodal communication (including solutions for patients with various impairments, e.g. automatic fingerspelled alphabet recognition basd on video transmission - useful for deaf people), brain-computer interfaces (BCI) and neuroprostheses, for control and communications systems for people after central nervous system damages,
rehabilitation robots (Lokomat) and nursing robots, assistive robots for telerehabilitation and care automation purposes [10],
communications systems (internet access, mobile phones, wireless standards like Bluetooth 3.0 HS, etc.), providing communications services for all subsystems, including mobile user (e.g. on wheelchair),
Global Positioning System (GPS), providing remote localization systems,
e-learning, e-work and adaptation computers to the needs of people with impairments [11], car adaptation systems (exoskeleton ReWalk allows car driving), augmented reality and virtual reality (VR),
advanced nanomedical solutions, including bio-MEMS and bio-NEMS or controversial RFID
technology [12, 13],
cybertherapy and cyberrehabilitation,
future solutions, new drugs and medical methods.
Integrated environment as an open system can be easy to upgrade according to the current needs (e.g. development in disabled children or relapse in health status in elderly patients).
Synergy of described element can provide better result than use of each of them independently. There is need to pay particular attention to not “overloading” of integrated environments. They should be individually tailored according to needs and preferences of the patient. Patients, particularly elderly or with severe cognitive impairments, can be reluctant to the big amount of machines around him. The result won’t be as good as could be. What more - sometimes there can be necessity to provide somebody from patient’s family as a discrete observer and “helpdesk” -maybe grandson will be a better teacher for his grandpa then experienced medical staff.
Integrated solutions for disabled, severely ill and elderly people
Disabled people’s integrated IT environment (see Fig. 1) can be easily adapted for severely ill or ageing people.
BOTH INDOOR AND OUTDOOR OR OUTDOOR ONLY
Fig. 1. Disabled person’s integrated IT environment [4, 6, 8, 11].
Fig. 1 did not contain communication, management and security elements of the described environment. It depends both on the environment components and user requirements.
Wider use of integrated environments can provide:
1. increase of effectiveness and accessibility of outpatient/home care and rehabilitation,
2. resulting increase of accessibility of hospital care,
3. decrease of costs,
4. providing care and rehabilitation in friendly home environment, close to the family, what can influence to motivation,
5. acquired abilities (e.g. in the area of activities of daily living - ADLs) are closer to daytime routine.
Despite aforementioned issues we should be aware of treats which are as follows: dehumanization of mecicine/health care, resistance of patients, especially older, data security threats within IT systems.
Directions of further research
Presented environments can be the supplementary solution for “classic” rehabilitation, especially as outpatient (home) solution. It seems be essential for physical therapists to participate in development of integrated environments of disabled people, both as scientists and as experienced clinicians. It allows to develop physical therapy in required direction. This way physical therapists can influence future tools of their work. What more, research in the area of integrated environments for disabled person are be interdisciplinary. Authors of this article are an example of scientists team from both areas: physical therapy (medical sciences) and technical sciences (IT, artificial intelligence, automation, robotics, biomedical engineering, rehabilitative engineering).
As a main part of further research in the area of integrated solutions for disabled, severely ill and elderly people are perceived:
reliable and valid ways of proposed solutions’ assessment, according to the Evidence Based Medicine (EBM) paradigm, clear clinical prescribing area,
standardization of solutions, especially in the area of new technologies, medical staff graduate and postgraduate education,
patients and their families/carers education and training, especially in the home care and rehabilitation,
high quality, ergonomy and patients safety, e.g. avoiding secondary injuries and equipment-related accidents.
Conclusion
No doubts development of technical solutions for disabled, severely ill and elderly people is one of possible ways to increase their independence and quality of life. Future solution should be safer, adaptable, more effective, widely available and easy to use. It allows even people with limited physical, perceptual and cognitive skills to increase their abilities and independence. Accelerating of presented integrated environments, expected during incoming years, require close co-operation among medical staff (including PTs), biomedical engineers and other specialists.
It is necessary to pay particular attention to fact, that not always sophisticated solutions are the best. Sometimes very simple (and cheap) solutions can be very useful - their force lies in a good co-operation with the others solutions in the system and proper fitting to patients requirements. It emphasize importance of knowledge and experience of medical staff (physician, physical therapists, occupational therapists) and engineers in choosing proper solutions.
Open Access
This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
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This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.
Received: October 15, 2011 Revised: October 16, 2011 Accepted: October 16, 2011
