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Virtual Coaching Activities for Rehabilitation in Elderly

Periodic Reporting for period 2 - vCare (Virtual Coaching Activities for Rehabilitation in Elderly)

Reporting period: 2019-03-01 to 2021-03-31

Against the background of demographic development, the continuity of care from the professional treatment into the home environment becomes critical to ensure the patients’ quality of life (QoL). As QoL is deeply related to the patients’ abilities to engage in their care and the health expectations of them, evidences show that one of the most relevant domains is the rehabilitation after an acute pathological episode or in the course of a disabling chronic disease. Rehabilitation is a complex process by which a patient and a multitude of professional caregivers are involved. Rehabilitation usually begins in the acute-care hospital after the person’s health condition has been stabilized. Secondly and ideally, at home the rehabilitation team is continued and enriched by additional caregivers, including the “informal” ones, until the daily routines in the home environment are sufficiently manageable again. Even though rehabilitation does not “cure” the effects of a disease (i.e. in stroke it does not reverse brain damages), rehabilitation can substantially help people to achieve the best possible long-term outcome living independently, and participating in everyday life.
Unfortunately, the continuity of rehabilitation often interrupts with the transition to the home. Virtual Coaches can be a key technology to ensure the continuity of care, reinforce self-management, enhance adherence to the care plan and risk prevention and ultimately empower patients. Rehabilitation guidance by a virtual coach does not replace specialists but rather supplements their work to guarantee the continuity of care in the home environment.
Therefore, the vCare project develops and investigates a Virtual Coaching solution encapsulating a set of coaching services for empowering and motivating people, helping them to proceed with a personalized rehabilitation by means of a virtual avatar. For this, vCare monitors the patients’ daily activities, conditions, and habits to provide personalised feedback to recover the QoL. For that, the coaching programmes are initialised by specialists by assigning a well-elaborated clinical pathway as a tailored rehabilitation plan to the patient (according to the personal context). According to this plan, vCare enables the personalization of the intensity and way of interaction and will trigger suitable exercises (serious games, cognitive training programs, etc.), suggestions and feedback.
Refraining from static rehabilitation programmes the continuous adaptation to patients’ needs and context ensures the patients’ empowerment to adequately deal with their circumstances. In general, there would be two options in case a patient leaves the desired range. Firstly, the physician could intervene and take measures to come back on track. Secondly, the Virtual Coach could intervene as it is in immediate proximity and permanently examines the patient. The Virtual Coach’s expertise has to be enriched by means of providing medical knowledge, sequence plans or interaction schemes in terms of modes that are usable for the Virtual Coach. This relates to clinical pathways (as the representation of the adequate treatment procedure), smart-home sensors (replacing the eyes of a human caregiver) or sensors for vital data, the avatar itself (replacing the caregiver’s face and interaction possibility) or the machine learning and reasoning (replacing the human’s assessment abilities).
After closing the conceptual project stage with four core deliverables in the first reporting period, the system implementation started with the TechLab prototype. Therefore, each component was deployed accordingly to the architecture and connected via a common messaging layer. During the TechLab, the communication flows specified were implemented and the interplay of the components were tested based on pre-defined core activities. In parallel, the clinical pathways which set the baseline for the coaching activities were revised and enriched with technical details that are necessary to integrate them into the care process. In the final workflow, the practitioners can edit and store the pathways in the pathway modeler. After publishing them, the pathways are available in the professional portal and can be refined and prescribed to a concrete patient. The Virtual Coach interacts with the patient according to the boundaries the pathway set but will also personalize the interaction using different motivational messages, or educate the patients concerning their behavior and personal risks.
LivingLab phase started, in which the Virtual Coaching solution was implemented into a controlled environment at the premises of each medical partner. Three LivingLabs have been implemented for the pathologies of Stroke, Parkinson`s Disease, and Heart Failure. Due to the COVID-19 pandemic situation, the engagement of patients in the living-lab phase proved to be more challenging than expected. The consortium has thus decided to focus firstly on some critical activities such as those involving modules related to physical rehabilitation and the testing of the professional portal. The situation is, however, now quickly evolving, and the recruitment of patients is accelerating. The Living-Lab phase was initially supposed to end in May 2021 but will be extended to August 2021. In addition to the LivingLab prototype, users are involved continuously in the design process. E.g. already in the phase of the TechLab, feedback was collected from each reference site with the help of a demo video that shows the main functions of the coaching solution and its application in their specific situation.
The vCare project aims to go beyond the state-of-the-art technology integrating and processing different data sources to personalize the coaching recommendation based on clinical pathways and patient preferences. Therefore, the project mission is to utilize the virtual coach in terms of the virtual avatar as communication mean for the patient. Acting like a physical coach, the VC channels the information and provides suitable recommendations to the patient, as well as engages the patient “like a coach” to stay in their training plan and also provides a backlink of the outcome as well as a possibility of intervention to the physician.
The vCare solution is deluged with several sensors to evaluate patient’s health status, care plan adherence, and other factors that are necessary for smooth recovery of quality of life. It also provides an interface for caregivers to extract patients’ relevant information and to tune the treatment.
Further, vCare will integrate semantic technologies (reasoning, behavioural models, predictive analytics, going beyond only rule-based but more intelligent adaptations), well-elaborated coaching services and clinical pathway services having the virtual coach as the central and controlling element.
The VC encapsulates coaching and supportive services as well tele-monitoring services. The latter provide the data-related basis for the virtual coach’s decision logic and as well as tracing data the service provision is based on.
However, the innovativeness of vCare does not only reside in the utilization of single technologies but in the combination of these technologies. This is to individualise/personalise the home care/rehabilitation and somehow fill the gap the caregiver’s in the home environment absence has caused.