Design, development, and validation of innovative motor telerehabilitation systems

Telerehabilitation is a branch of telemedicine that aims to rehabilitate the patient from remote, with the help of ICT solutions. By bringing the rehabilitation tools to the patients’ home, providing ways to control their progress and correct their errors, telerehabilitation systems promote fair access to the treatments also for those patients who live far from the rehabilitation centers or present limited autonomy in reaching them. As telerehabilitation limits the real-time interaction with the rehabilitation staff and the exercises are usually repetitive and boring, the main risk is the reduction of the compliance to the prescribed protocol. In long-term rehabilitation situations, this often leads to dropouts, thus limiting the recovery. To avoid such problems, an interesting development is the use of playful tools, such as video games, for rehabilitation purposes. These tools are called exergames because they help the patient to exercise in a gamified scenario. Although exergame-based rehabilitation systems are moving from the research to the market, the combined use of low-cost platforms, telerehabilitation based on quantitative measurements of biomechanical parameters, and exergames is still seen as the holy grail in the field. This is due to the complexity of these systems, which limits the adoption of low-end computing platforms, and to the quality of the sensor-based movement analysis, which is usually inadequate for telemonitoring purposes. Moreover, commercial solutions developed for this aim reveal severe limitations in the functionality and are closed systems with limited, when even possible, extendibility. Costs and accessibility for patients with low computer literacy are further problems that are seldom addressed. This thesis presents the design, development, and technological validation of a telerehabilitation system for stroke survivors with mild motor impairment, based on low-cost, wearable, and portable technologies. Such a system was developed in the context of the DoMoMEA project. Collaterally, beyond-state-of-the-art solutions were studied and here presented to innovate in the field of technologies for rehabilitation. In particular, advanced manipulation of the visual feedback in exergames was explored, to mimic, in exercises against gravity only, some effects achievable with haptic robots. Moreover, the validation of technologies for the development of smart clothing for telerehabilitation was pursued, with particular emphasis on the possibility to detect surface EMG signals during rehabilitation exercises. Such technologies could be easily integrated in the developed telerehabilitation platform for advanced studies. Preliminary validations, hampered by the COVID-19 pandemic in the last year, were obtained on healthy people.