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This section describes the methodology applied for the definition of the common set of exercises to be used for home rehabilitation. It is clear how the role of rehabilitation is important to improve functional independence and social re-integration and it is evident how within TBI, Stroke and MS there are a lot of common aspects regarding impairment and functionality at the upper limb. On the other end, specific aspects of impairment and activity limitation exist within the three pathologies, for example behaviour and global cognitive disturbances in TBI or fatigue in MS can be neglected in stroke patients. In recent years, despite home based medical services have been adopted in different countries, few studies have been performed about the efficacy of home-based rehabilitation. One of the difficulties seems the monitoring of performance and therapeutic activity at home. The present project aims at investigating whether it is possible to propose a common home-based rehabilitation platform that can improve the functional recovery of the upper limb in the three pathologies. As far as the rehabilitation treatment of the three pathologies is concerned, the common functional impairment that are looked at by the rehabilitationist can be summarised as follows:

  1. Limitation of the range of motion of the arm
  2. Strength decrease
  3. Involuntary movement
  4. Cognition
  5. Behaviour
  6. Familiar environment
  7. Difficulties of coordination
  8. Fatigue during endurance tests
  9. Muscular tonus

It is worth mentioning that against such complex background doctors face the pragmatic difficulties to decide which aspect requires attention as a priority and to define the most effective rehabilitation treatment. The objective of the H-CAD project will be therefore to define a common set of tools and a common set of exercises that can be performed and adopted by the patient in a home environment. The purpose of the tools will be to assess functions and implement the rehabilitation program at home. It is clear from the above that assessment and treatment modalities should include common instruments for the three pathologies and specific tools for each pathology, which means, in engineering terms, a common modular instrumental basis that can be upgraded with specific rehabilitation tools. In order to define such modular common base of rehabilitation tools for home care treatment, the methodological approach pursued has linked, to each functional impairment above described, the user requirements for a treatment performed in a home environment. In practical terms, for each pathology the following additional set of information have been added:

Such information, built in the form of a matrix, has been made for MS, Stroke and TBI patients. From the comparison of the matrices, information regarding a common set of tools for home care treatment has been therefore obtained. In order to define a common set of tools it is necessary to have the precise definition of the patients’ needs in terms of rehabilitation program based on evidence emerging from scientific literature. The followed path is depicted in the figure below.
methodological approach diagramd
Figure 1: Methodological approach for the definition of the functional specifications of the system

The inclusion criteria have been defined, in order to use appropriately the tools in exercises for a subset of MS, Stroke and TBI patients. Then, for each group of patients, information regarding his/her needs will be added and compared for the definition of a common set of tools that will represent the modular base of the H-CAD system.

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