This contribution will focus on the possibilities and challenges for the implemetation and scale up of innovative applications in the context of Dutch healt care. What are the opportunities and show stoppers for the deployment of eHealth techniques? What is needed to meet these challenges?

Independency is of highest importance in people with disabilities. This counts for the past, present and certainly in the future. Autonomy and social participation are key values to strive for. Supportive technical devices like prostheses, orthoses and wheelchairs can help to regain and remain functional skills and tasks. They can actually improve the persons abilities to stay independent. The interaction between the adaptive capabilities of a person and the adaptive capacities of the assistive device will define the level of functional ability. Technical improvements like actuation and artificial intelligence in these assistive devices makes them more and more functional embedded to the human body.

Will it be possible to improve the original?

Ankle-foot orthoses (AFOs) are often prescribed during rehabilitation after stroke. Despite the frequent application, little scientific evidence is available to guide AFO-provision early after stroke. For example, long-term effects of AFOs after stroke are lacking and no information with respect to the timing of the AFO-provision post-stroke is available. Therefore, a randomized controlled trial was conducted to study the effects of AFO-provision in (sub-)acute stroke patients. Two different randomized moments of AFO-provision were compared: provision at inclusion of the study, which was within 6 weeks after stroke, and provision eight weeks later. The effects on several functional clinical scales, falls and gait pattern will be presented.  

Running is a popular sport but, unfortunately, the incidence of running related injuries is very high. It is assumed that at least one out of two runners will get injured somewhere in their running career. Jasper Reenalda will discuss in this presentation the relation between running mechanics and injury development and how knowledge gained within the MeasuRun projects at Roessingh Research and Development is used to develop a mobile feedback system for runners to assist in injury prevention. In the MeasuRun projects, the influence of fatigue on running mechanics has been studied extensively by using inertial sensors to perform motion analysis in the natural environment of the runner (“on the road”). Fatigue is generally assumed to be one of the key components in the etiology of running related injuries. Several parameters have been identified in the MeasuRun projects that change significantly as a consequence of fatigue and that can be linked to injury development.
The feedback system that is currently being developed in the MICT SensoRun project, consists of inertial sensors and a smart device, that will continuously monitor the individual running mechanics and, by using a biomechanical model, is able to give personalized feedback on relevant parameters in the individual running technique that are associated with running related injuries. As such it will contribute to a Life Long Running. 

Deploying a physically active lifestyle is essential for our health and wellbeing and to support independent living, especially for elderly. Gaming technologies are believed to offer opportunities to increase the motivation of elderly for physical activity without additional burden on both formal and informal health care. Despite the fact that the elderly population is an important, large, growing and power-purchasing target population for games, very few of the available games today specifically target the elderly population and their specific needs and wishes. In this presentation we will discuss the state of the art in mobile gaming solutions to promote physical activity in daily life. What motivational game elements are mostly used and do they work? Next, we will discuss the development and evaluation of a mobile activity game for elderly: the MAGGY game. This game combines ambulant activity sensing with appropriate motivation strategies in a mobile gaming environment, to give playful tailored feedback to the elderly throughout the day, anytime and anywhere. 

In 1964, Marry Poppins sang: "A spoonful of sugar helps the medicine go down".
Games potentially are the new sugar to support patients in their rehabilitation or in general vitality programs. In this talk, we explore the opportunities of games and gaming as supporting technology in adherence to medical advice. 

The presentation will shortly discuss why applied games are required for use within rehabilitation and what benefits they bring with them. In addition, based on experience gained within two recent game projects, we will discuss how applied games are developed and how they may be used in rehabilitation. 

Upper-limb rehabilitation robotics can be beneficial tools for robot-assisted therapy. These technologies provide motivational and interactive therapy for the patient and can perform quantitative measurements of post-stroke impairments and degree of recovery for therapists and clinicians. A major question is in which way technology can provide the largest benefit, especially regarding application in clinical practice. In this presentation, I will give an overview of several types of devices and will discuss their current and potential impact on the rehabilitation outcome. 

Achieving and maintaining an active lifestyle is important for everyone. For the ageing population, a proper physical condition can delay functional decline, reduce the risk of falls, and as such, increase the time period in which people can live independently in their home environment. The eWALL platform is a Smart Home platform designed to aid older adults living independently at home, by offering various services aiming to improve both physical and cognitive functions as well as support in the self-management of chronic diseases. In this talk we provide an overview of the eWALL platform and focus on some of the services it offers that target physical activity monitoring and coaching.

Using a number of examples from implementation projects and field studies, the current role of robotics in clinical practice will be described. Besides the question whether therapy using such applications is effective, the topic of practical feasibility is at least as important. Do clinicians and patients have the desire and ability to use technology as a part of the rehabilitation? In what way is that achievable in clinical practice? And will the application of robotics change daily (rehabilitation) practice in terms of contents or structure?

Evaluations come in many different forms and shapes, especially when you want to evaluate a technology-supported health intervention. Technical stability, usability, user experience, acceptance, and clinical effect. What should you aim for? And how do you make a proper evaluation setup? In this presentation, we will untangle the different evaluation goals and the most important evaluation designs for technology-supported health services. Our goal is to let you leave as a full-fledged telemedicine evaluation expert, or as close to that as we can come in 15 minutes…

In Roessingh we have been working on the implementation of enhanced technology in our rehabilitation-programs for several years. We have developed an online intervention through close collaboration of end-users and developers. This has resulted in an integrated system, www.Telerevalidatie.nl, soon to be connected to our Electronic Health Record. This intervention is implemented in rehabilitation programs for lung disease, oncology, chronic fatigue and stroke. Through research-projects, conducted together with UT and Saxion University, the implementation process is studied and supported. A current example is NaDien, an online aftercare program for chronic pain patients.

The use of rehabilitation technologies at home after stroke, such as a passive dynamic wrist and hand orthosis combined with computerised gaming exercises, could enable patients to train independently and ultimately serve as a way to enhance the dosage of practice. But do people actually want to use such a device? And if so, will they benefit from it, compared to performing conventional exercises from an exercise book?

Living with pain online is a digital program for patients with chronic pain, developed by the University of Twente (UT). The program is based on Acceptance & Commitment Therapy and is effective for chronic pain patients in decreasing pain interference, psychological distress and pain. During an RCT, participants were supported by weekly e-mail contact with a counselor. Currently the intervention is implemented in a blended-care format with chronic pain patients of Roessingh Rehabilitation Centre (RCR). In addition, the online aftercare program NaDien, which is also based on ACT, is developed by UT and RRD in close collaboration with patients and professionals of RCR. This program is currently tested in a randomized controlled trial among patients of RCR.

In the past decades, we have seen tremendous advances in technologies for neurorehabilitation. Unfortunately, most of these solutions have a strong engineering drive and do not consider what really matters to the users. While interaction between researchers, clinicians and patients is improving worldwide, there are crucial aspects of technology transfer that are often overlooked. In this talk, I will share with you some of what I have learned while working in the medical industry. The aim of this talk is to foster discussion on different key factors that are needed to make technology-assisted rehabilitation a real deal-breaker in healthcare.

The rapid evolution of technology has allowed health professionals to begin to adapt to these changes and deliver healthcare in a new, remote fashion. More recently, telemedicine has come into play. Telemedicine is seen as an enabler of change because of its high reach and low-cost solutions. The change towards technology-based practice is an extremely relevant area for health professionals to effectively treat a variety of patient groups. However, most health professionals still orient their practice behaviors to an acute-care model and have little formal training in the delivery of telemedicine interventions designed to support the care of chronic diseases.

This presentation shows the development of a telemedicine service that focuses on home-based exercising for different patient groups and the adoption of these programs by patients and their health care providers. Suggestions to improve adoption are offered.

Over the years RRD has contributed significantly to the development of a new generation of tools for 3D movement analysis, based on small wearable movement sensors. The concept for the first sensors, developed at RRD in the 90s, arose from a clinical need for ambulatory kinematic assessment in (back pain) patients. Still, so far only successful large scale applications have emerged in non-clinical areas as movie and game production and motion tracking of single-piece gadgets like drones, mobile phones and VR headsets.

Starting from the Fusion project in 2010 RRD and its partners have identified and tackled the remaining challenges blocking successful large scale application in rehabilitation, physical therapy, sports and ergonomics. As a result a family of low-cost, technically absolutely hassle-free and quick-to-apply methods has been developed. These are currently being tested for use in routine clinical application.

Still, for the large group of unsupervised applications at home, at work or during sports this is not enough. Most of these also require ‘context awareness’ (information about current activity, intention and location / environment of the subject). New solutions for context assessment that can adapt to a particular application and available sensor configuration, based on modern machine learning and enhanced sensor technology, are currently investigated in multiple projects and presented here.

In the recent years, RRD gained a lot of expertise and experience in screening of elderly followed by tailored online coaching. This experience was built in projects including Perssillaa, Life and Langgezond. But how to sustain these activities in daily life? How to create impact; how to valorise these activities for sustainable use?

In this presentation, we share how our screening and coaching experience are brought to the market.

The growing demand for care for people with chronic conditions, requires more efficient diagnostics and treatment, while on the other hand the rapidly evolving sensor and information technology offer opportunities for real innovative solutions. A wide range of services are being developed, supported by technology, that will change rehabilitation dramatically. We will move towards a personalized extramural set of diagnostic and treatment services fully integrated in the home environment and with a combined offering of safety, wellness and comfort. In my presentation, I will address topics like non-obtrusive monitoring of health and functioning, intelligent personalized coaching, new ways of human interaction and decision support for health care professionals.

The rapid development in rehabilitation technologies has been fueled by our better understanding of neuroplasticity and the importance of intensity of practice in recovery, advances in wearable and environmental sensors, signal processing techniques and the internet. Never before have we had such an opportunity to improve rehabilitation outcomes, but are we exploiting it effectively?

In the talk in the afternoon, prof. Jane Burridge will discuss in more detail the garments introduced in the plenary morning session.

In the talk in the afternoon, prof. Jane Burridge will discuss in more detail the garments introduced in the plenary morning session.