The Evolution of Personalized Behavioral Intervention Technology
Will It Change How We Measure or Deliver Rehabilitation?
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Telehealth access, mobile communication, instrumented devices, and wearable sensing technologies can be configured by internet connectivity to hover like an invisible personal drone, curating continuous data about physical activity, mental state, and physiology, even body and environmental chemistry, during everyday life.1,2 The figurative drone can gather ground truth via direct observation of disabled persons after a stroke during their daily activities or rehabilitation practice, then transmit measurements of interest to clinicians and researchers with high accuracy in real time. The technology can be configured to ask about and record in-the-moment self-reports about mood, pain, social interaction, activity, and other personal events. After stroke, it can enable patients to receive rehabilitation in their homes and communities when little or no therapy would otherwise be available.
Telerehabilitation includes tools for standard telemedicine in which personalized health care is delivered at a distance by, for example, videoconferencing. Mobile health (mHealth) supports these remote interactions between patients and clinicians with smartphone-based text messaging, video streaming, e-mail, health-related apps, and other wireless technologies, such as wearable motion and heart rate sensors. Instrumented exercise and practice devices with radio connectivity to the internet can also stream a record of training and progress.
The conceptual bases for such applications to outpatient rehabilitation and clinical trials are subsumed under the motor learning theory that dominates stroke rehabilitation practices. That is, an adequate dose of repetitive practice at relevant tasks that are increasingly challenging and optimized by behavioral reinforcement, along with exercise for strengthening and conditioning, will best support training-induced neuroplasticity and potentially improve outcomes.3 Usual outpatient rehabilitation tends not to offer feedback and relies on informal or ordinal measures of progress. Feedback from multidimensional mHealth monitoring technologies may better motivate and guide compliance, training intensity, and progression when therapists incorporate sensor-derived ground truth about …