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Telemedicine makes it possible for doctors to diagnose and treat diseases even if the patient is not sitting in the doctor’s office, but rather at home in front of a screen. The technical requirements for this remote medicine have developed rapidly in recent years. Blood pressure, blood sugar, weight, ECG, and a lot of other relevant body data are available in the doctor’s office at the push of a button and can be evaluated there. Scientists and physicians at the University of Potsdam are working on a telemedicine program for rehab patients who need lengthy physical therapy after hip or knee surgery.
Bright dots dance across the black grid display. On the screen, you can vaguely recognize that these points belong to a person. Legs, back, and head are visible. "The recording has started," Nina Tilgner calls into the adjacent room. The physiotherapist, who researches at the Potsdam University Outpatient Clinic, is looking at the monitor and operating a camera system that records the following. The dots on the screen begin to move in coordination, slowly up and down. Next door, a woman is doing sports in the test rooms of the university outpatient clinic. This patient got a new knee joint three weeks ago. Markers are attached to her body – to her joints, back, and head. About 20 points are visible on the monitor. Ten cameras record her movements. Two physiotherapists are standing at her side to make sure that the exercises do not overexert the recently operated joint. Squatting, lunging, abducting a leg when standing, and standing on one leg – the program is challenging.
What is happening at the outpatient clinic are the first steps of a comprehensive project. “ReMove-It – Rehabilitation through telemedical assisted movement therapy after lower extremity intervention” is a joint project of science, medicine, and technology. It is also one of the first ambitious research projects of the newly established Research Initiative for Health Sciences at the University of Potsdam. The aim of this interdisciplinary initiative is to “establish health sciences at the University of Potsdam as an independent field of research, to bundle, develop, and strengthen the available expertise,” explains Prof. Frank Mayer, Medical Director of the University Outpatient Clinic, who is also spokesman of the initiative together with Prof. Gerd Püschel of the Institute for Nutritional Sciences. In addition to the academic institutes, practioners are pillars of this project.
These resolutions are taking shape in the ReMove-It project. The program is intended to support patients in completing long-term rehab exercises at home after hip or knee surgery. In line with the research initiative, the participating institutions are actors from various disciplines who contribute their expertise. Apart from the University of Potsdam, these include MEDIAN Klinik Hoppegarten, Brandenburg Klinik Bernau, Reha-Zentrum Lübben, Fraunhofer Institute for Open Communication Systems (FOKUS), and the Professorship for Sports Medicine and Sports Orthopedics at the University of Potsdam. “Our goal is to develop training sessions for patients who live in structurally weak regions to enable them to continue their rehab exercises at home,” explains Heinz Völler, Professor of Rehabilitation Sciences at the University of Potsdam and Medical Director of the “Klinik am See” in Rüdersdorf, who is leading the project. It is important for patients with artificial hip and knee joints to continue their exercises after rehabilitation. In rural regions, however, the distance to therapists offering follow-up treatment is often far away – too far for some. Therefore, many patients do not take advantage of them. Völler and the other researchers want to change this with their project. The exercises are to be done with a physiotherapist during rehabilitation and continued with an individual training program in front of a screen at home. More people who have had hip or knee surgery should complete the important follow-up treatment. The study is sponsored by the Deutsche Rentenversicherung Berlin-Brandenburg with € 876,000.
The exercises performed by the first test patient under the eyes of 10 cameras and two physiotherapists are expected to provide the initial evidence of how much physical strain she can endure. A squat done by a person who recently had knee surgery looks different from that of a healthy person. “We create a catalog with exercises for strength, stretching, and flexibility,” explains Sarah Eichler, sports scientist and coordinator of the project. “From the experiences gained by our physiotherapists, we know what is appropriate for this group of patients.” ReMove-It started in January 2015; the training catalog of about 25 exercises is now nearly finished. Now the training sessions are going to be biomechanically measured and implemented into a mathematical model developed by a group of researchers led by Dr. Michael John at the Fraunhofer FOKUS. John is Deputy Head of the Competence Center E-Health at the participating Fraunhofer Institute. "MeineReha®" is the name of the system’s prototype, which has already been developed here and which will be tailored to the specific requirements of the study. The challenge is to adjust the system so that the movements vary within a certain range. “Of course, there is always an ideal way the movement should look. We need to develop the mathematical algorithms and models for the motion analysis and evaluation of the sequences. We have to be realistic, however, and allow for a margin of possible deviations from the ideal movement,” John explains.
To define this leeway, more patients will be coming to the University’s outpatient clinic to be measured during exercise in the coming weeks. “We are interested in the positions of the markers to each other during the exercises. How far can the knee protrude over the toes during a squat or how deep can the bend be?” Eichler describes the procedure. Angles and distances between the individual markers on the subjects’ bodies are registered and analyzed. The result is a program that records the patient’s movements and checks their correctness via camera, similar to a Wii game console. A traffic light system provides instant feedback as to whether the movements are as they should be. The workouts are also recorded and can be viewed at any time by attending physiotherapists. Even video conferencing and chats between therapist and patient are intended.
The next step is to ask patients of a working age at the cooperating rehabilitation clinics to take part in testing the system. Each participating hospitals will acquire a total of 10 pieces of equipment for € 1,500 each and place them at the disposal of 55 subjects. The other half of the 110 subjects will undergo traditional post-operative treatment. Initially, the patients’ physical performance will be determined by strength and stress tests. After three months, the researchers will take stock and compare the two groups. Has the group under telemedical care done their exercises more consistently? Has the system been accepted? Has there been any impact on the recovery process and physical fitness? Can the patients who use the assistance system get back to work faster than those from the control group? Using comprehensive data collection, the researchers will investigate these questions.
In addition to the obvious advantages, the cumulative expertise of the various professions in this ambitious project creates a very special challenge. “It is a great endeavor. Each partner in this project has his or her own goals and interests – technicians, scientists, physicians, and physiotherapists – but each can contribute a lot to its success,” explains Eichler.
Prof. Heinz Völler is a specialist in internal medicine, cardiology, and social medicine. He is Medical Director of the „Klinik am See“. Since 2012 he has held the Professorship for Rehabilitation Sciences at the University of Potsdam.
Department Sport- und Gesundheitswissenschaften
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Sarah Eichler studied sports science and English studies at Kiel University and the Berlin Humboldt University. Since 2013 she has been researching at the Professorship for Rehabilitation Sciences of the University of Potsdam.
ReMove-It – Rehabilitation through telemedical assisted movement therapy after lower extremity intervention
Participating: University of Potsdam, MEDIAN Klinik Hoppegarten, Brandenburgklinik Bernau, Reha-Zentrum Lübben, Fraunhofer Institute for Open Communication Systems (FOKUS)
Funded by: Deutsche Rentenversicherung Berlin-Brandenburg
Text: Heike Kampe, Translation: Susanne Voigt
Online-Editing: Agnes Bressa
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