JOURNAL CRITISMNEUROLOGIC SYSTEMThe SMART Rehabilitation System for Stroke Self-management: Issues and Challenges forEvidence-based Health Technology Research

Oleh :M Taufik Bachtiar 105070200131008Anissa Karomatul Baroroh 105070201131017Awaliya Ramadhan 105070207131005A.Alfian Zein Mutaqin135070207131003

JURUSAN ILMU KEPERAWATANFAKULTAS KEDOKTERANUNIVERSITAS BRAWIJAYA MALANG2014

The SMART Rehabilitation System for Stroke Self-management: Issues and Challenges forEvidence-based Health Technology Research

1. TopicThis journal decribes about the rationale for the use of technology for the remote rehabilitation of stroke survivors and describes the research findings used to inform the design, development and deployment of the SMART device for upper limb self-managed rehabilitation (Sue Mawson, Gail M. Mountain, 2011). SMART rehabilitation system is a set of tools used to assist in the management of training motion for stroke patients based on blue-tooth technology and internet.

2. Background and significanceStroke is one of the major causes of disability in the UK with over 100,000 cases of first stroke and 3,000 cases of further stroke every year. In the USA, it is the third leading cause of death and serious long-term disability. This journal describes to assist people to self-manage the medical aspects of long term conditions. This paper presents the rationale for the use of technology for the remote rehabilitation of stroke survivors and describes the research findings used to inform the design, development and deployment of the SMART device for upper limb self-managed rehabilitation (Sue Mawson, Gail M. Mountain, 2011).

3. The Research SampleThe case studies in this journal involving 4 stroke survivors with a mean age of 61.5 years old consist of 2 male and 2 female, were used in the final stages of prototype deployment for the SMART system.

4. Analysis journalThe SMART rehabilitation system uses motion sensor technology to track functional movement of the impaired upper limb. Once the sensors have been attached in the correct locations on the arm and chest and the equipment assembled, users wait for confirmation that the system is ready and then undertake an exercise from a library of prescribed interventions (eg, reach out and stretch the arm and then return). Users undertake a series of repetitions before receiving feedback on quality and range of movement from a decision support interface developed specifically for the prototype. Several forms of feedback about exercise performance are possible (Sue Mawson, Gail M. Mountain, 2011). The SMART manikin displays, on a computer screen, a rendered model of the users upper-limb movement so that comparison can be made between the user movement and the target. Exercise graphs also are available to illustrate the extent to which the user movement matches the target exercise. If there is a perfect match, the user receives a score of 100 for that exercise

Figure 1. The SMART Telerehabilitation Systems First Prototype(Sue Mawson, Gail M. Mountain, 2011).

At the time of this study, the SMART system was comprised of 2 Xsens orientation sensors, sensor attachments, and a small media PC and touch screen. The Xsens orientation sensor is a small box, measuring 39 x 54 x 28 milimeters and weighing 35 grams. Each sensor is connected by a wire to a device (100 x 150 x 40 milimeters, 278 grams) worn at the waist. The device communicated wirelessly (Bluetooth) with a small media PC. The user interface to the PC was via a touch-screen. The sensor attachments were made of soft, elastic neoprene-type material. During the case studies, the SMART system was installed in the patients home. Users and their care-givers received training in how the SMART system was operated and received a hardcopy of the SMART Reference Manual.Technical support was available throughout the case study in the event of equipment malfunction.TELER is a measurement system based on clinically significant change over time. It is a method of clinical note making that incorporates three 6-point ordinal scales within the analysis (TELER Indicators). These scales were previously validated indicators or were individually constructed for each patients functional needs, ensuring that the impact of the SMART prototype is clinically important to the stroke individual. TELER indicators were chosen from the TELER stroke library by the patient and the therapists to reflect the desired outcomes to be achieved.From the explanation above, be aware that technology is an applicative SMART system to assist in the rehabilitation of stroke patients. SMART technology can make it easier for patients and families of patients in an attempt to train the patient to move. These methods use blue-tooth technology and the internet. How to use is:1. Install the sensor with the PC, and SMART system software on the PC2. a master censorship ( a x bus master ) in place at the waist , the two other sensor ( a mt 9 b ) in put at the extremity will be exercised. 3. Connecting the sensor and PC using Bluetooth4. wait for confirmation that the system is ready 5. there are the display of a motion picture in pc . the patient should adjust by motion seen in pc . that table there are score system , where if the patient move perfect motion, patient gets a score of 100.Here patients and family shouldnt have to worry, because this therapy is still monitored by the therapist. Here, the patients PC must also be connected to the internet so the therapist can still monitor the patient exercise. Of course this requires a system of a fast internet connection in order to facilitate monitoring.5. Journal CriticismNegative side : Because SMART system use Bluetooth, PC, and internet connection, so, it depends on the electricity and internet connection. Because the SMART system use internet service, so the therapist cant interact directly with the patient. This device is not portable, so it cannot be transferred easily to another place, moreover to remote villages that lack internet connection The devices are expensive, so not all people can buy. The therapists who were consulted had difficulty accepting the incorporation of terminology different from that in which they had been educated and socialized. For example cycle time was not as acceptable as timetaken or speed of movement.Positive side : Make the patient independent, because he/she can exercise by him/herself. The devices use a modern technology, such as sensor box, bluetooth, personal computer, moving picture, and internet service. This invention can open the new idea to make next research about telehealth Scoring system in SMART system make high motivation to the patient. This system can increase the role of nurse as the educator because nurse can assist the therapy although patient stay at home.

6. Application in IndonesiaIt will could be done in Indonesia but only on a certain society or only on a community can pursue in order to use the internet connection is fast. In addition to the circumstances and the mindset of Indonesia's population as well influencing this sooner or latest technology applied in Indonesia.Nursing responsibility:Explain to clients and families regarding the purpose of the exercise movements of the joints. Monitor the location and discomfort during exercise. Review the client's ability to Teach movement active/passive ROM on san client family. Active/passive movement aims to maintain the flexibility of joints. Here, nurse can also act as theraphist

REFERENCEMawsonJ.Sue and Gail M. Mountain. 2011. The SMART Rehabilitation System for StrokeSelf-management: Issues and Challenges for Evidence-based Health Technology Research. Journal of Physical Therapy Education Vol 25, No 1, Winter 2011Downloaded on Novemberr 28th 2011from :http://content.ebscohost.com/pdf25_26/pdf/2011/IKI/01Jan11/56553282.pdf?T=P&P=AN&K=2010897078&S=R&D=rzh&EbscoContent=dGJyMNHr7ESeqLU4zOX0OLCmr0meqLBSsay4Sa%2BWxWXS&ContentCustomer=dGJyMOzprkiup7JNuePfgeyx633i3%2BF56gAA