Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter August 5, 2014

Development and validation of tele-health system for stroke rehabilitation

  • Rachel Kizony EMAIL logo , Patrice L. Weiss , Orit Elion , Sharon Harel , Ilanit Baum-Cohen , Tal Krasovsky , Yoram Feldman and Mordechai Shani


Tele-rehabilitation refers to the use of information and communication technologies to provide rehabilitation services to people in their homes or other environments. The objective of this paper was to present the development, validation, and usability testing of a low-cost, markerless, full-body tracking virtual reality system designed to provide remote rehabilitation of the upper extremity in patients with stroke. The Methods and Results sections present the progress of our work on system development, system validations, and a feasibility/usability study. We conclude with a brief summary of the initial stages of an intervention study and a discussion of our findings in the context of the next steps. The validation study demonstrated considerable accuracy for some outcomes (i.e., shoulder “pitch” angle, elbow flexion, trunk forward, and side-to-side deviation). In addition, positive responses were received from the clients who participated in the feasibility study. We are currently in the process of improving the accuracy of the system and analyzing results from a randomized clinical trial, which assessed the effectiveness of the system to improve upper extremity function post-stroke.

Corresponding author: Rachel Kizony, OT, PhD, Lecturer, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel; Department of Occupational Therapy, University of Haifa, Haifa, Israel; and Chaim Sheba Medical Center, Tel Hashomer, Israel, E-mail:


The authors thank Yuri Fayans, Yossi Konigsberg, and Anat Cohen for lending their skills in programming the Kinect SDK and the tele-game applications.


1. Burdea G, Popescu V, Hentz V, Colbert K. Virtual reality-based orthopedic telerehabilitation. IEEE Transactions Rehabil Engineering 2000;8:430–2.10.1109/86.867886Search in Google Scholar

2. Bowling A. Aspirations for older age in the 21st century: What is successful aging? J Aging Hum Dev 2007;64:263–97.10.2190/L0K1-87W4-9R01-7127Search in Google Scholar

3. Winstein CJ, Merians AS, Sullivan KJ. Motor learning after unilateral brain damage. Neuropsychologia 1999;37:975–87.10.1016/S0028-3932(98)00145-6Search in Google Scholar

4. Deutsch JE, Lewis JA, Burdea G. Technical and patient performance using a virtual reality-integrated telerehabilitation system: Preliminary finding. IEEE Transactions Neural Syst Rehabil Eng 2007; 15:30–5.10.1109/TNSRE.2007.891384Search in Google Scholar PubMed

5. Kairy D, Lehoux P, Vincent C, Visintin M. A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation. Disabil Rehabil 2009;31:427–47.10.1080/09638280802062553Search in Google Scholar PubMed

6. Bendixen RM, Levy CE, Olive ES, Kobb RF, Mann WC. Cost effectiveness of a telerehabilitation program to support chronically ill and disabled elders in their homes. Telemed e-health 2009;15:31–8.10.1089/tmj.2008.0046Search in Google Scholar PubMed

7. Durfee W, Carey J, Nuckley D, Deng J. Design and implementation of a home stroke telerehabilitation system. Annu Int Conf of the IEEE 2009:2422–5.10.1109/IEMBS.2009.5334951Search in Google Scholar PubMed

8. Golomb MR, Barkat-Masih M, Rabin B, Abdelbaky M, Huber M, Burdea G. Eleven months of home virtual reality telerehabilitation-Lessons learned. Virtual Rehabilitation International Conference, 2009:23–8.10.1109/ICVR.2009.5174200Search in Google Scholar

9. McCue M, Fairman A, Pramuka M. Enhancing quality of life through telerehabilitation. Physical Medicine and Rehabilitation Clinics of North America 2010;21:195–205.10.1016/j.pmr.2009.07.005Search in Google Scholar PubMed

10. Mountain G, Wilson S, Eccleston C, Mawson S, Hammerton J, Ware T, et al. Developing and testing a telerehabilitation system for people following stroke: Issues of usability. J Engineering Design 2010;21:223–6.10.1080/09544820903333792Search in Google Scholar

11. Microsoft 2011. KinectSDK for Windows. Accessed on 2013 Apr 05. URL: in Google Scholar

12. Lange B, Flynn SM, Rizzo AA. Game-based telerehabilitation. European J Phys Rehabil Med 2009;45:143–51.Search in Google Scholar

13. Schönauer C, Pintaric C, Kaufmann H. Full body interaction for serious games in motor rehabilitation. Proceedings of the 2nd Augmented Human International Conference 2011, Tokyo, Japan, ACM.10.1145/1959826.1959830Search in Google Scholar

14. Suma EA, Lange B, Rizzo AA, Krum DM, Bolas M. FAAST: The Flexible Action and Articulated Skeleton Toolkit. Proceedings of the IEEE Virtual Reality, 2011:247–8.10.1109/VR.2011.5759491Search in Google Scholar

15. Lange B, Rizzo AA, Chang C-Y, Suma EA, Bolas M. Markerless full body tracking: Depth-sensing technology within virtual environments. Interservice/Industry Training, Simulation, and Education Conference (I/ITSEC) 2011, Paper 11363.Search in Google Scholar

16. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;327:307–10.10.1016/S0140-6736(86)90837-8Search in Google Scholar

17. Folstein MF, Robins LN, Helzer JE. The mini-mental state examination. Arch Gen Psych 1983;40:812.10.1001/archpsyc.1983.01790060110016Search in Google Scholar PubMed

18. Wilson HA, Cockhurn J, Halligan PW. Behavioural Inattention Test Manual Fareham. Hants, England: Thames Valley Test Co. and Los Angeles: Western Psychological Services, 1987.Search in Google Scholar

19. Fugl-Meyer AR, Jääskö L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med 1975;7:13–31.Search in Google Scholar

20. Kizony R, Katz N, Rand D, Weiss. PL. A Short Feedback Questionnaire (SFQ) to enhance client-centered participation in virtual environments. 11th Annual Cyber Therapy Conference: Virtual Healing: Designing Reality, Gatineau, Canada, 2006.10.1037/e695432011-079Search in Google Scholar

21. Borg G. Psychophysical scaling with applications in physical work and the perception of exertion. Scand J Work Environ Health 1990;16:55–8.10.5271/sjweh.1815Search in Google Scholar PubMed

22. Kizony R, Weiss, PL, Elion, O, Harel S, Baum-Cohen I, Feldman Y, et al. Evaluation of a Tele-Health system for upper extremity stroke rehabilitation. Submitted to the International Conference on Virtual Rehabilitation, Philadelphia, 2013.10.1109/ICVR.2013.6662096Search in Google Scholar

23. Huijgen BC, Vollenbroek-Hutten MM, Zampolini M, Opisso E, Bernabeu M, Van Nieuwenhoven J, et al. Feasibility of a home-based telerehabilitation system compared to usual care: arm/hand function in patients with stroke, traumatic brain injury and multiple sclerosis. J Telemed Telecare 2008;14:249–56.10.1258/jtt.2008.080104Search in Google Scholar PubMed

24. Piron L, Turolla A, Agostini M, Zucconi C, Cortese F, Zampolini M, et al. Exercises for paretic upper limb after stroke: a combined virtual-reality and telemedicine approach. J Rehabil Med 2009;41:1016–102.10.2340/16501977-0459Search in Google Scholar PubMed

25. Chumbler NR, Quigley P, Li X, Morey M, Rose D, Sanford J, et al. Effects of telerehabilitation on physical function and disability for stroke patients: A randomized, controlled trial. Stroke 2012;43:2168–74.10.1161/STROKEAHA.111.646943Search in Google Scholar PubMed

26. Langen J, DeLave K, Ohillips L, Pangilinan P, Brown S. Home-based telerehabilitation shows improved upper limb function in adults with chronic stroke: a pilot study. J Rehabil Med 2013;45:217–20.10.2340/16501977-1115Search in Google Scholar PubMed PubMed Central

27. World Health Organization, 2009. Accessed on 2013 Apr 05. URL: in Google Scholar

28. Schwamm LH, Holloway RG, Amerenco P, Audebert HJ, Bakas T, Chumbler NR, et al. A review of the evidence for the use of telemedicine within stroke systems of care: a scientific statement from the American Heart Association/American Stroke Association. Stroke 2009;40:2616–34.10.1161/STROKEAHA.109.192360Search in Google Scholar PubMed

Received: 2013-5-8
Accepted: 2013-6-28
Published Online: 2014-8-5
Published in Print: 2014-9-1

©2014 by De Gruyter

Downloaded on 30.11.2023 from
Scroll to top button