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