la continuità di cura in neuroriabiltazione: i risultati ... · la continuità di cura in...
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La continuità di cura in neuroriabiltazione: i risultati dei progetti ABILITY ed HEAD per la definizione di un modello efficace e
sostenibile
Francesca Baglio
Torino, 4 Ottobre 2017
SIAMOC 2017 – Baglio F
La continuità di cura in neuroriabilitazione
• Overall vision, key-themes
• ABILITY programme
• HEAD programme
OUTLINE
SIAMOC 2017 – Baglio F
Population pyramids for developed countries [mln of people]
LIFE EXPECTANCY AND DISABILITY
GBD, Lancet 2015; 386, 743-800
SIAMOC 2017 – Baglio F
COMMUNICABLE DISEASES vs NOT CD
GBD and HALE, Lancet 2015; 386, 2145-91
SIAMOC 2017 – Baglio F
DISABILITY AND LIFE
… “ about an eighth of life expectancy
worldwide is associated with
disability … It is clear that more
and better data about disability are
needed” …
P Byass Lancet 2016; 386, 2121-2
SIAMOC 2017 – Baglio F
Revolutionising management …
A community for people suffering from Parkinson
Bloem BR, Munneke M. BMJ. 2014; 348:g1838
SIAMOC 2017 – Baglio F
• Overall vision, key-themes
• ABILITY programme
• HEAD programme
OUTLINE
SIAMOC 2017 – Baglio F
Around 47 million people were living with dementia in 2015 making it a major global challenge of the 21st century
The Lancet DOI: 10.1016/S0140-6736(17)31363-6
DEMENTIA
130 million people
SIAMOC 2017 – Baglio F
Alzheimer’s disease: expedition into the unknown
… “While knowledge is gained in the aetiology and fine detail of Alzheimer’s disease, research must also focus on lifestyle interventions.
This is not the soft stuff ; it might save lives.” The Lancet
The Lancet 2016; 388:2713.
SIAMOC 2017 – Baglio F
MST [www.clinicaltrials.gov (NCT01893398)]
SIAMOC 2017 – Baglio F
IMPROVEMENT WORSENING
NPSY : Global Cognitive Measures
… “There was a significant difference between treatment and control groups in total ADAS-Cog score (p = 0.01) and in the language subscale (p = 0.01)” ...
SIAMOC 2017 – Baglio F
CTR
PWA_pre PWA_post
NEUROIMAGING – LANGUAGE TASK
SIAMOC 2017 – Baglio F
effect of treatment: flexible-factorial design
tMST>ntMST
NEUROIMAGING: EFFECT OF TREATMENT
SOSTENIBILITA’ ??? Nuovi modelli di care andando a casa
ABILITY PROGRAMME
ABILITY is a research project Funded (2014 –2015) within the Smart Cities and Smart Communities (EU-Lombardy Region funding program).
Budget: 4.08 M€, with 1.632 M€ co-funding (Lombardy Region) Duration: 18 months Domain: Social Innovation (ageing society, domotics)
IRCCS Fondazione Don Carlo Gnocchi
Università degli Studi Milano – Bicocca
Politecnico di Milano (POLIMI)
Industries and SMEs Companies
Research Institutions Healthcare Centers - Universities
THE ABILITY CONSORTIUM
Telbios SpA Astir Srl Teorema Engineering Srl Secure Network Srl AB Tremila SRL Sait Srl
ASL della Provincia di Lecco Comune di Milano
PAs involved
DEMENTIA SCENARIO in ITALY
Caregiver
Neurologist
Neuropsychologist-therapist
Nurse
Social
Services
Person
with dementia
Without Ability: Care is provided by
Hospital/Outpatient Setting
Home
80% Self-care (unpaid family carers)
20% Professional care
Caregiver
Neurologist
Neuropsychologist
-therapist
Nurse
Social Services
Person with dementia
With Ability: Smart Care Community
ABILITY: OVERALL VISION
New way for aging care:
PWD at the core Links all actors Supports CGs
fragmented →integrated care
Caregiver
Neurologist Neuropsychologist-therapist
Nurse
Social Services
The Ability Smart Community
ABILITY: HOW ?
With an integrated platform of services aimed at supporting and enhancing the rehabilitation process for PWD , with special focus on home-based care.
Technological interventions have the potential to improve care delivery but should not replace social contact.
What’s the role of Technology in Ability ?
by Gill Livingston, Dementia Commission, The Lancet on July 19 (2017)
Nature 2016; 531, S14–S15
INFRASTRUCTURE: WEB-BASED PLATFORM
It’s set to meet the different needs of all the subjects involved (physicians, patient, caregiver, family …)
PLURAL perspectives
For
TeleMONITORING (activity, vital parameters ...)
TeleREHABILITATION (Individual Rehabilitation Plan)
ABILITY SYSTEM: SPECIFIC CONTENT
PLATFORM
DEVICES for
teleMONITORING
to collect patient’s
data at home daily activities
vital parameters gaming sessions
TOOLS for
teleREHABILITATION
engagement of people using VR and serious games ecological and experiential training environment
Studies: integrated system
Usability of integrated System
Efficacy: the Ability-TelerehABILITation study protocol for a randomized controlled trial.
(Realdon et al, BMC Psychiatry 2016. 25;16:425.)
PERFORMANCES OF ABILITY SYSTEM
Studies: individual components
Usability and acceptability study of Indoor localization solutions
Usability of a computerized Stroop Test for clinical application.
(Coelli et al, 2016 IEEE RTSI)
Usability of haptic feedback devices for upper limbs physical rehabilitation
(Covarrubias et al,Disabil Rehabil Assist T
echnol. 2014; 9:335-43)
ABILITY
MAIN RESULTS
TRATTAMENTO CONVENZIONALE VS ABILITY
1.High compliance due to home
assistance
2.Continuos monitoring
3.Mantaining level of cognitive abilities
4.Generation of big data to be analyzed
5.Standardization of treatment to be
exported
IN CONCLUSION (1/2)…
LIMITATIONS
1. Need of caregiver to start and
support the tratment
! Learnability
OPEN PROBLEMS
1. Privacy and ethics
2. Evaluation of cost-effectiveness
IN CONCLUSION (2/2)…
SIAMOC 2017 – Baglio F
La continuità di cura in neuroriabilitazione
• Overall vision, key-themes
• ABILITY programme
• HEAD programme
OUTLINE
NOVITA’ : FILMATI
ASPETTO MOTIVAZIONALE
HEAD – TECNOLOGIE
CONCEPT HEAD
ClinicHEAD HomeHEAD
Kohler et al, J Neuroeng Rehabil. 2010; 7: 2.
TRIAL: CONSORT FLOW DIAGRAM
ClinicHEAD HomeHEAD
S
P
M
P: PD in stable treatment for at least 3 years and with a H&Y score ≤ 2
ARRUOLAMENTO (ENROLLEMENT): CHI ?
M: MS without relapses in the last 3 months and with a EDSS score ≤5.5
S : stroke in the chronic phase, at least 6 months after the acute event
SUBJECTs
S
P
M
Age: P≠ S,M [pcorr <.05]; Scol: n.s.; Gen: n.s.
ARRUOLAMENTO (ENROLLEMENT): TARGET 100
ClinicHEAD
12 sessions 3sess/week
Activities: 1+2+3
ClinicHEAD: PROGRAMMA
Sensore PPG Fotopletismografo che misura il volume dell’impulso del flusso del sangue (BVP)
Sensore accelerometro Tri-Assiale misura attività motoria
Sensore EDA Misura la conduttanza elettrica della pelle (attività elettrodermica)
Valutazione attività in HEAD EMPATICA: Cosa misura
Sensore di Temperatura Misura temperatura cutanea
ACCELERAZIONE
Palleggia e guarda (MAI) Allenamento
Palleggia e guarda (MAI)
Nuota e vai (MAS)
Prendi e Sposta (MAS)
Ordina e Vinci (CM)
Abbina simbolo (CMDT)
Campionamento 32Hz
Risultati ACCELERAZIONE 1/2 LONGITUDINALE
N=36 SM= 11 PD =13 STROKE= 12
Risultati ACCELERAZIONE 2/2 TRASVERSALE su singola seduta
Cognitivo/motorio motorio cognitivo
HR
segnale BVP
HR =Heart rate
IBI = Interbeat interval
Campionamento 64 Hz
Palleggia e guarda (MAI) Allenamento
Palleggia e guarda (MAI)
Prendi e Sposta (MAS)
Prendi e Sposta (MAS)
Ordina e Vinci (CM)
Abbina simbolo (CMDT)
HRV
HRV
HRV
la linea rossa identifica il picco del battito. Dalla distanza tra picchi successivi, deriviamo l’intervallo cardiaco, battito dopo battito
Tracciato IBI (inter beat interval)
Cortesia ing Castiglioni Paolo
CONCLUSIONI HEAD
S
P
M
Target migliore: coinvolgente ed efficace sia su aspetti motori che cognitivi
Aspetti cognitivi meglio di quelli motori
Cammino e equilibrio
HomeHEAD
P Stern et al. Science 2014;346:566-567
... “as we age, our brains constantly reorganize in response to new experience” ...
TECNOLOGIA UNA NUOVA ESPERIENZA