The RGS@HOME project: Scaling ICT based neurorehabilitation to personalized 24/7 home care

Project description

The RGS@HOME project advances science grounded neurorehabilitation methods, which can be used by patients during the full patient journey. RGS targets motor and cognitive recovery after stroke and is based on brain theory, delivering rehabilitation and diagnostics using Al, virtual reality, and cloud computing. RGS has proven to speed-up recovery and drastically reduces the length of treatment received by patients at hospitals. RGS@HOME extends the existing research portfolio and commercial products developed by SPECS-lab and its spin-off Eodyne Systems S.L.

It has been projected that the burden of stroke will increase markedly in Europe, from 1.1M cases per year in 2000 to more than 1.5M per year in 2025, solely because of the demographic shift. Consequences can be devastating and long-term, requiring a high level of care and resulting in high costs, estimated by Eurostat to grow in the E.U. from 16B€ in 2010 to €27B per year. Hence, it is essential that new approaches are deployed that help to efficiently manage these chronic conditions. 

The solution proposed in this project capitalizes on a novel ICT-based treatment product at TRL9, the Rehabilitation Gaming System (RGS). RGS implements rehabilitation protocols grounded in neuroscientific principles. RGS integrates a paradigm of goal-oriented, embodied action execution with motor imagery and action observation, including reinforcement mechanisms, online adaptation, and multimodal feedback. The effectiveness of these rehabilitation principles based on the Distributed Adaptive Control theory of mind and brain is supported by RGS's clinical impact [1,2] and by direct fMRI confirmation [3], showing that RGS accelerates recovery in subacute and chronic stroke patients. In a recent pilot study, chronic stroke patients' Activities of Daily Living (ADLs) were shown to both improve as compared to a control group and to correlate with significant cortical reorganization [4]. For instance, our latest findings reveal that the development of debilitating compensatory behaviors, such as learned non-use, can greatly interfere with the recovery dynamics and prevent the retention of improvements, thus leading to "rehabilitation in vain" and a remarkable loss of adherence [5]. RGS establishes a closed loop of recovery in which limb use and functional recovery reinforce each other or a virtuous cycle of recovery [5]. In addition to its impact on motor function, RGS is based on identified principles [6] has been successfully applied to the rehabilitation of aphasia [7], cognitive and affective disorders [8], and shown to enhance recovery at any period post-stroke [9]. Given its success in stroke rehabilitation, RGS is currently also generalized to other deficits of brain function, including addiction, cerebral palsy, and dementia. In addition, a model based diagnostics and monitoring pipeline is being developed building on the Virtual Brain and its BRAINX3 front-end which are advanced in the EC project Virtual brain Cloud.

RGS has delivered over 7500 hours of rehabilitation to over 300 patients across Europe and provides evidence-based decision-making for optimal hospital discharge schedules. In addition, RGS reduces the need for direct supervision by therapists and clinicians and provides them with advanced monitoring, analytics, and reporting tools. These tools allow for the quantitative assessment of relevant properties of deficits and recovery and facilitate a number of eHealth applications that support at-home rehabilitation, patient autonomy, data-driven recovery assessments, and remote monitoring by secondary/tertiary users. The copious amount of clinical evidence supporting the effectiveness of RGS and the advanced stage of development of its unique set of features positions the RGS as an advantageous and unique ICT-solution for the facilitation of improvement, retention, and generalization of recovery post-stroke. The RGS@HOME project provides a complete strategy for the adoption of a new approach to neurorehabilitation by patients, clinicians, and reimbursers. The RGS@HOME strategic agenda combines four primary action plans aligned with the European Institute of Technology Health's strategic objectives: 1) to allow the remote monitoring of data-driven recovery measures and early detection of stroke relapse, 2) to facilitate the patient's transition from the clinic to the home, therefore, promoting the patient's empowerment, 3) to provide evidence-based prognostics for clinical decision-making on hospital discharge schedules and for patient-tailored therapy protocols, and 4) to introduce an ICT-based ecosystem for value-based healthcare delivery models. 

[1] Cameirao, M.S., et al., RNN(2011)

[2] Cameirao, M.S., et al., Stroke(2012)

[3] Prochnow, D., et al., EJN(2013)

[4] Ballester, B.R., et al., JMIR(2017)

[5] Ballester, B.R., et al., JNER(2016)

[6] Maier M., et al., NNR (2019)

[7] Grechuta, K., et al., Stroke (2019)

[8] Maier M., et al., JNER (2020)

[9] Ballester, B.R., et al., JNP (2019)

Key facts

Time frame: 2019-2021

Origin: Spontaneous Application

Funding: EU funding