(I-342) Portable, touch-based, multi-modal assessment and therapy device (MAT) for for post-surgical, neurological, and TBI assessment and rehabilitation

Introduction:: Neurological assessments and therapies are critical components of medical care. Over 795,000 people in the U.S. have a stroke each year, and strokes result in reduced mobility in over half of survivors who are over 65 (CDC). It can take months to years of intensive therapy and rehabilitation activities for complete recovery (CDC), at a cost of approximately $14 billion annually (Breen et al., 2017). Common upper limb surgeries also result in lengthy recovery periods. Specifically, rotator cuff surgery recovery takes 4-12 months and approximately 24-48 visits therapy visits, yet there are currently no simple, inexpensive, precise devices for rotator cuff assessments (MacGillivray). Additionally, thousands of clinical visits are required annually for assessing and treating concussion and TBI. Research shows that the dominant computer-based system used to assess high school and college athletes, the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), is often improperly used to determine fitness to return to activity (Covassin et al., 2009), and due to issues with the reliability of ImPACT test-retest scenarios a multifaceted approach to concussion management is suggested (Resch et al., 2013). There is a demonstrated need for increased access to neurologic assessment and therapy devices and services, and our inexpensive, portable, touch-based Multi-modal Assessment and Therapy device (MAT) is designed to support customizable, on-demand, game-based patient interaction for a range of post-surgical, neurological, and cognitive assessment and rehabilitation activities.

Materials and Methods:: The Multi-modal Assessment and Therapy device (MAT), has a customizable, touch capacitive or force-sensing array that supports a range of physical assessments or therapeutic activities. MAT’s patient interface displays instructions directing the patient to perform a series of touches on the array, and a clinician interface displays the results to the clinician. MAT has a central, vertical arm that can selectively arc forward to a radius determined by the patient’s arm length. Placing the touch array on this arc allows the clinician to assess shoulder lateral extension, the primary assessment for rotator cuff recovery. The display instructs the patient to raise their arm to touch the highest array element they comfortable can, and the angle is reported to the clinician. The other arms of the MAT device can be positioned rotationally, like an airplane propeller, and the touch array can be arranged to support a variety of physical therapy or neurological activities. Stroke therapy can be performed by placing the array outward from the center of the device to encourage the patient to reach laterally thus increasing mobility, and further customization of the array elements can support occupational therapy activities or assessments of concussion or TBI. User tactile interaction with array elements results in selective control of output LEDs. LED colors, flashes, or other non-auditory feedback, including haptic feedback, encourages patient interaction and provides game-style interaction. Devices include custom fabricated rotational components. The conductive fabrics and threads, force sensing elements, capacitive sensors, microprocessors, and displays are from Adafruit Industries.


Results, Conclusions, and Discussions:: MAT, shown in figures 1A-1D, addresses the lack of simple, effective, and accessible devices for post-surgical and neurological assessments and therapies, including activities for surgical recovery, stroke recovery, and concussion/TBI assessments. The clinician interface permits customization activity protocols, data collection, displays relevant patient performance. The patient interface has accessibility features including displaying instructions in image or text format. MAT’s touch array is customizable to support a variety of activities, and the textile areas adjoining the touch array elements can be customized to the user’s style preferences. For example, a pediatric patient can enjoy an assessment where they are challenged to touch certain superheroes, and an adult patient might enjoy a touch array of songbirds or classic cars. MAT has arms that are positioned rotationally or that alternatively fold behind the central arm for storage. MAT is inexpensive, portable, and suitable for field-based, home, or remote care. Moreover, MAT operates without sound to support sound-averse patients.



There is a demonstrated need for accessible and affordable therapeutic devices and services, and MAT is designed to address this need. MAT is simple and provides game-style interaction with minimal complexity. Because MAT is inexpensive and operates without sound, MAT reduces common barriers to neurological devices and services. Future work includes consultation with experts in orthopedics, neurology, and occupational therapy to develop an expansive and effective menu of assessments and therapeutic protocols. Additionally, our team is collaborating with experts to design appropriate clinical trials.






Acknowledgements (Optional): : Research reported in this presentation was supported in part by the Rhode Island Institutional Development Award (IDeA) Network of Biomedical Research Excellence from the National Institute of General Medical Sciences of the National Institutes of Health under grant number P20GM103430

References (Optional): : CDC. “Stroke Facts | Cdc.Gov.,” 14 Oct. 2022, https://www.cdc.gov/stroke/facts.htm.

Breen, Joan, et al. “Abstract TP148: Characteristics and Estimated Rehabilitation Costs for Stroke Survivors Treated in a Community-Based Interdisciplinary Outpatient Rehabilitation Program Who Return to Work.” Stroke, vol. 48, no. suppl_1, Feb. 2017, pp. ATP148–ATP148.

MacGillivray, J. “Rotator Cuff Surgery: How It Works, Recovery Time | HSS.” Hospital for Special Surgery, https://www.hss.edu/conditions_torn-rotator-cuff-surgery.asp.

Covassin, Tracey, et al. “Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) Practices of Sports Medicine Professionals.” Journal of Athletic Training, vol. 44, no. 6, 2009, pp. 639–44.

Resch, Jacob, et al. “ImPact Test-Retest Reliability: Reliably Unreliable?” Journal of Athletic Training, vol. 48, no. 4, 2013, pp. 506–11.