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A recent telehealth bill – the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act (S. 1016) – focuses on expanding the use of telehealth among Medicare insured individuals. It will enable physicians to expand remote monitoring programs for chronic patients. As a consequence, more physicians and patients will be inclined to use the state-of-art technologies in telehealth [1].

At present, 4D hologram technology is considered a cutting edge technology in telehealth.

As compared to traditional 2D webcam videos, 4D hologram technology is more useful in the assessment of gait and movement. But is this technology in telehealth space market ready? 4D hologram technology uses Kinect cameras to capture the images and data from the patient. To understand the market readiness of this technology, it is worthwhile to start with exploring the research related to the clinical efficacy of Kinect cameras.

This paper initially summarizes research studies that have validated the use of Kinect in the clinical setting. Secondly, it focuses on studies that specifically conduct neurological, stroke assessment using telemedicine. Lastly, it discusses few future trends and possibilities for the next year.

Kinect cameras in clinical settings

The trend to study clinical efficacy of KINECT cameras has accelerated over last ten years. The number of academic papers on Kinect, as indexed by PubMed, have doubled [2]. Kinect cameras are useful in clinical settings as they provide high quality images that cover 4D space about 4 meters in depth and an angular field of view of 30 degrees to right and left [3].

The validity of Kinect camera to assess postural changes in healthy individuals has been studied. It is a reliable and valid measure for assessing movements such as standing balance, forward reach, and lateral reach [4]. Furthermore, the validity of Kinect cameras for examining hand speed analysis has also been done. This study, in particular, provides a strong basis to use Kinect cameras the assessment of movement disorders [5].

Kinect camera has been used in elderly patients to detect large movements such as fall detection in unoccluded settings [6]. Kinect cameras can detect smaller movements well. In research settings, Kinect cameras are used to study a variety of movement disorders such as parkinson’s disease, cerebral palsy, multiple sclerosis, and muscle dystrophies. These studies aimed to perform an assessment on the clinical population and also rehabilitation which requires frequent assessments [2].

Stroke rehabilitation using telemedicine

Stroke rehabilitation takes several weeks during which a patient needs to visit her care providers frequently. Due to its ease and precision, telemedicine has been increasingly used in the stroke rehabilitation. This enables patient to be in comfort of their homes or nearby local clinic and yet receive necessary standard care.

The use of Kinect camera/sensor has widely been accepted as the much needed precise assessment tool for the movement data in stroke patients. A recent study using Kinect camera evaluated upper body movements on eight performance indices in patients undergoing stroke rehabilitation. The study reported that three performance indices – mean velocity (MV), logarithm of dimensionless jerk (LJ), curvature (C) – were more sensitive than others. Across the therapy sessions, acceptable reliability and sensitivity was noted [6].

A recent systematic review summarized findings of over twenty stroke rehabilitation studies and concluded that Kinect has significant potential to be the low cost, effective motion capture system. The studies primarily focused on the upper limb motor activities and noted that Kinect camera provided acceptable spatial accuracy. The review also discusses Kinect based games that are used for stroke rehabilitation and fall prevention in elderly. These games help improve various measure such as eye-hand coordination, reaction times, and physical function [7].

Future trends

Currently, in telemedicine 4D holographic technology is employed for some use cases such as movement disorders. 4D holographic technology is used in a limited capacity such as a research rehabilitation settings or for follow-up visits after the diagnosis has been provided on the first visit. In other words, although the clinical efficacy of 4D hologram technology is established, its clinical effectiveness is still being explored.

We foresee three major trends emerging in the next few years. We anticipate that in the future 4D holograms will be widely accepted and become a standard of care in telehealth. Secondly, medical professionals will use the technology not only for follow up visits but also for initial visits. The clinical effectiveness of the technology will be widely studied in a variety of settings. It will offer new hope to the rural areas where clinics are sparse and traditional telemedicine has failed due to its lack of precision. Additionally, sharing kinetic data acquired from 4D holograms will become a norm among care professionals and regulations that govern data transmission will further evolve to include holographic patient data.

At BioVirtua, we intend to study the entire continuum from clinical efficacy to clinical effectiveness for the 4D holographic technology. We are setting up a pilot study in the most prestigious healthcare institution within New York City to assess the clinical efficacy of BioVirtua platform for stroke rehabilitation therapy and later in the next year, we will move towards assessment of clinical effectiveness.

References:
1] http://www.apta.org/PTinMotion/News/2017/5/4/MedicareBill/
2] https://www.hindawi.com/journals/jme/2014/846514/
3] http://ieeexplore.ieee.org/document/6549755/

https://www.google.com/url?q=https://www.google.com/url?q%3Dhttp://ieeexplore.ieee.org/document/6549755/%26amp;sa%3DD%26amp;ust%3D1503004764304000%26amp;usg%3DAFQjCNGyYsShXbFCQ_kTQFkPvcuJf3j7Yg&sa=D&ust=1503004764315000&usg=AFQjCNG_xDcLN_ov2MlzvvASUGSrZsY8Fw

4] https://www.ncbi.nlm.nih.gov/pubmed/22633015
5] https://biomedical-engineering-online.biomedcentral.com/articles/10.1186/1475-925X-13-88
6] https://jneuroengrehab.biomedcentral.com/articles/10.1186/1743-0003-11-108
7] https://biomedical-engineering-online.biomedcentral.com/articles/10.1186/s12938-015-0070-0

Author: Aditi Joshi is the Head of Research Innovation at BioVirtua.

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