Editorial

Innovative Technologies for

Rehabilitation and Health Promotion:
What Is the Evidence?
s new technologies enter the market or the research development track, physical

A therapists increasingly are in positions to either guide or lead the development

team, working with engineers to adapt and modify existing technologies or

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develop new technologies to enhance rehabilitation, prevent decline, monitor change, or
maintain healthy living. Remarkable breakthroughs have occurred in rehabilitation robot-
ics,1–3 the brain-computer interface,4 – 6 virtual reality (VR)– based therapies,7–10 wearable
sensors and monitors,11–13 and all forms of interactive media applications for rehabilita-
tion and health behavior. There still are significant gaps in knowledge about how to best
to use these technologies to reduce disability broadly, but we know that many of these
technological developments provide the opportunity for new strategies and interven-
tions to enhance quality of life for people with disabilities and chronic conditions that
affect function and mobility:

• New technologies have the potential to reduce environmental barriers—for instance,

“smarter” homes and buildings allow tasks to be performed with minimal human input, and
mobility and communication equipment minimizes the impact of underlying impairments on
activity and participation.
• Usual service delivery is enhanced by telerehabilitation, which facilitates training via the web,
telephone, or other technology over great distances.
• The Internet and social media allow more people with (and without) disabilities to connect
with one another and support each other in real time in a way that was impossible before.14

The physical therapy profession can be central to ensuring the development and optimal
use of new technologies to reduce disability and enhance healthy living.

In preparing for PTJ’s special series on innovative technologies for rehabilitation and
health promotion, we were particularly interested in receiving contributions about
current technologies that have the potential to accelerate progress in physical therapy
and rehabilitation strategies, techniques, and interventions. We sought contributions that
used both theoretically and empirically based principles to inform and enhance inte-
grated interactive technologies and clinician-delivered rehabilitation solutions in collab-
oration with diverse end-users and professionals who have scientific, clinical, and engi-
neering expertise. Only through these interdisciplinary approaches can we advance and
strengthen the foundations of rehabilitation interventions and the seamless interface of
rehabilitation and technology.15

This special series presents cutting-edge research and perspectives that capture the
essential role that new technologies can play in physical therapy and rehabilitation
practices globally. The articles showcase research and case reports from established
authors, including physiotherapists/physical therapists from the United Kingdom,
Australia, Israel, Canada, and the United States. In addition to the global perspective
To comment, of our international authors, there is considerable interdisciplinary expertise across
submit a Rapid the articles, and the research teams include rehabilitation engineering, arts and
Response to this technology, occupational therapy, physical therapy, medicine, and computer
editorial posted online science.
at: ptjournal.apta.org.

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 Editorial

The technologies and patient groups are equally diverse:

• Transcranial direct current stimulation (TDCS) for children with pediatric hemiparesis16
• Virtual reality following adult stroke10,17,18 and for children with developmental coordina-
tion disorders19
• A novel force sensor system for detecting progression in Parkinson disease20
• An iPhone exercise application in people with familial dysautonomia21
• A mixed reality or interactive neurorehabilitation system for stroke rehabilitation22
• Body-worn sensors for balance and gait rehabilitation23

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In addition to the technology-focused research papers, there are 2 perspectives about
social media. These authors present distinct yet important views about the role of social
media in health care and health promotion. Knight and colleagues24 propose that
incorporating social media in both the design and delivery of physical therapist care can
enhance patient engagement in prescribed health behaviors and improve treatment
outcomes, whereas Gagnon and colleagues25 explore the policy implications of orga-
nizational adoption of health care social media and propose individual opportunities and
guidelines for social media use by the physical therapist.

As the physical therapy profession embraces the mobile health (mHealth) industry and
learns to optimally adapt it to the patient’s needs and expectations, we must be guided
by the evidence regarding mHealth technologies. Dicianno and colleagues26 describe
the evolution of mHealth technologies and how mHealth is used to improve patient
satisfaction, deliver care, and promote health and wellness—and they also discuss the
regulatory and funding challenges to mHealth. Levac and colleagues27 address the
development and preliminary evaluation of a knowledge translation resource to support
clinical decision making pertaining to the use of Kinect™ games in physical therapy.

In light of the recent explosion of interactive immersive technologies, including VR and

video games, the special series includes 3 distinct and important perspectives about the
role and effective application of VR-based tools for rehabilitation:

• Levin and colleagues10 discuss how motor learning and motor control principles can be
exploited by VR training environments, provide evidence concerning current applications
for upper limb motor recovery in stroke, and identify the limitations and opportunities with
respect to effectiveness and transfer of learning to daily life tasks.
• Proffitt and Lange18 contend that researchers must take a progressive, step-wise approach
through the stages of intervention development using evidence-based principles, take advan-
tage of recent data, and use standardized measurement tools in order to design effective VR
interventions that can be assessed in carefully designed efficacy and effectiveness trials.
• Baran and colleagues22 present an interdisciplinary approach in the development and use of
scalable interactive neurorehabilitation (INR) systems for upper extremity management of
patients with stroke. They propose a coherent approach to INR design to facilitate the use
of the systems by physical therapists, to increase the number of successful INR studies, and
to generate rich clinical data that can inform the development of best practices for use of INR
in physical therapy.

Most of the research presented in this series is early-stage feasibility or proof-of-concept

level, and more than a few papers noted small sample size as a limitation. We could At press time: During
move out of our parochial comfort zone to consider joining forces with our colleagues APTA’s Combined Sections
globally—and use information technology communication networks to not only bring Meeting in Indianapolis,
researchers, engineers, and clinicians together but to create rich shared databases that several special series
could be mined using sophisticated data mining techniques that are available only when authors came together for
there is a great deal of data. a panel discussion. Stay
tuned for the PTJ podcast.

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Computer scientists already are “mining from time series human movement data.”28
Tseng and Cook use human walking data collected from volunteers to identify age
categories and to detect possible changes in the individual’s health condition. They
applied wireless accelerometer sensors similar to those described by Horak and her
team23 in this special series. Some time ago, Mulroy and colleagues29 used cluster analysis
for gait pattern classification of patients in the early and late recovery phases following
stroke. Horak and colleagues highlight the importance of obtaining impairment-level
metrics of balance and gait from body-worn sensors to better characterize how and why
functional performance is impaired. Furthermore, the use of body-worn sensors presents
opportunities (and challenges) for monitoring participation in home exercise programs

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and for capturing the quality of natural mobility in the community.

As these technologies become smarter, and as they are connected through wireless
communication, more possibilities than we could have ever have imagined will open up
to advance the science. There is little doubt that advanced technologies will be a major
player in the future of rehabilitation and physical therapist practice. It is fair to say that
we are nearing the end of the beginning!

Special Thanks
This special series is the culmination of the efforts of many individuals. The enthusiastic
support from Editor in Chief Rebecca Craik and Editorial Board Member Sally Westcott
McCoy, PT, PhD, is greatly appreciated. The efficient management of these manuscripts
could not have been accomplished without the exceptional contributions of PTJ’s
Editorial Office. Last but not least, we want to acknowledge the manuscript reviewers
(listed on page 298) who extended their expertise and scientific prowess to provide
valuable and constructive feedback that contributed to the high quality of these
manuscripts.

Carolee Winstein, Philip Requejo

C. Winstein, PT, PhD, FAPTA, is a guest co-editor of this special series. She is Professor, Division of
Biokinesiology and Physical Therapy, and Director, Motor Behavior and Neurorehabilitation Laboratory,
Health Sciences Campus, University of Southern California, Los Angeles, California. She is a former PTJ
Editorial Board member.

P. Requejo, PhD, is a guest co-editor of this special series. He is Director, Rehabilitation Engineering
Department, and Associate Director, Pathokinesiology Laboratory, Rancho Los Amigos National Rehabili-
tation Center, Downey, California, and Adjunct Assistant Professor, Biomedical Engineering Department,
University of Southern California.

References
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2 Tefertiller C, Pharo B, Evans N, Winchester P. Efficacy of rehabilitation robotics for walking training in
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3 Krishnan C, Ranganathan R, Dhaher YY, Rymer WZ. A pilot study on the feasibility of robot-aided leg motor
training to facilitate active participation. PloS One. 2013;8:e77370. doi: 10.1371/journal.pone.0077370.
4 Collinger JL, Kryger MA, Barbara R, et al. Collaborative approach in the development of high-performance
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7 Laver KE, George S, Thomas S, et al. Virtual reality for stroke rehabilitation. Cochrane Database Syst Rev.
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with disability. Phys Med Rehabil Clin N Am. 2010;21:339 –356.

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9 Rizzo A, Requejo P, Winstein CJ, et al. Virtual reality applications for addressing the needs of those aging
with disability. Stud Health Technol Inform. 2011;163:510 –516.
10 Levin MF, Weiss PL, Keshner EA. Emergence of virtual reality as a tool for upper limb rehabilitation:
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11 Horak FB, Mancini M. Objective biomarkers of balance and gait for Parkinson’s disease using body-worn
sensors. Mov Disord. 2013;28:1544 –1551.
12 Spain RI, St George RJ, Salarian A, et al. Body-worn motion sensors detect balance and gait deficits in
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15 Winstein CJ, Requejo PS, Zelinski EM, et al. A transformative subfield in rehabilitation science at the nexus
of new technologies, aging, and disability. Front Psychol. 2012;3:340. doi: 10.3389/fpsyg.2012.00340.
16 Gillick BT, Feyma T, Menk J, et al. Safety and feasibility of transcranial direct current stimulation in
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17 Standen PJ, Threapleton K, Connell L, et al. Patients’ use of a home-based virtual reality system to provide
rehabilitation of the upper limb following stroke. Phys Ther. 2015;95:350 –359.
18 Proffitt R, Lange B. Considerations in the efficacy and effectiveness of virtual reality interventions for stroke
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19 Gonsalves L, Campbell A, Jensen L, Straker L. Children with developmental coordination disorder play
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21 Gefen R, Dunsky A, Hutzler Y. Balance training using an iPhone application in people with familial
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23 Horak F, King L, Mancini M. Role of body-worn movement monitor technology for balance and gait
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Manuscript Reviewers for PTJ’s Innovative Technologies in

Rehabilitation and Health Promotion: Special Series
Editor in Chief Dr Rebecca Craik and Special Series Co-Editors Dr Carolee Winstein and Dr
Philip Requejo gratefully acknowledge the manuscript reviewers who contributed their
time, expertise, and constructive comments to this special series:

Peter Altenburger, PT, PhD Mindy Levin, PhD

Amy Bastian, PT, PhD Rebecca Lewthwaite, PhD
Danielle Bellows, PT, MHS Rachel Lowe, Physiotherapy Bsc(Hons)
Rachelle Buchbinder, MBBS(Hons), Christine McDonough, PT, PhD

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MSc, PhD
Stacey DeJong, PT, PhD, PCS
Judith E. Deutsch, PT, PhD
Leland Dibble, PT, PhD, ATC
Elizabeth Domholdt, PT, EdD
Sean Dukelow, MD, PhD
Gammon Earhart, PT, PhD
Gerard Fluet, PT, DPT, PhD
Sheryl Flynn, PT, PhD
Nancy Getchell, PhD
Jill Heathcock, MPT, PhD
John Hewett, PhD
Hang Lee, PhD
Daniel Levac, PhD Candidate,
MSc, BScPT
Suzanne McDonough, PhD
David Morris, PT, PhD
Joe Nocera, PhD
Miguel Padilla-Castaneda, MSc
Margaret Plack, PT, EdD
Eric Robertson, DPT, OCS, FAAOMPT
Mary Rodgers, PT, PhD
Margaret Schenkman, PT, PhD
Marina M. Schoemaker, PhD
Maureen Simmonds, PT, PhD
Beth Smith, PT, DPT, PhD
Mary Stoykov, PhD
Laura Swisher, PT, M.Div., PhD
Ann Van de Winckel, PT, PhD
Jonathan Wolpaw, MD

[DOI: 10.2522/ptj.2015.95.2.294]

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