Toward an online rehabilitation exercise service based on personal independent living goals and risk management

In a nursing care domain, labor shortage is a significant problem. Information communication technologies (ICT) are expected as a tool to solve it. Care services, that value “personhood” of individuals, should be designed based on a person-centered principle[1]. We aim to develop an online rehabilitation exercise service that utilizes the ICT but is based on the principle. This paper reports a trial of intervention experiment of the online rehabilitation exercise, which was conducted as a 12-time event for three months. A subject, a female in 78 years old with left hemiplegia who desires more rehabilitation opportunities, joined about 45-minute online exercise sessions in addition to regular outpatient rehabilitations. She exercised by watching a model exercise on a tablet screen that is connected to the nursing facility. The model exercises were performed by an occupational therapist for the first four times and by on-site care workers for the rest. A manual with notes on exercise instruction was distributed to the workers. The instructor change and the manual are for the future regular operation of the service. The exercises were designed for not only the recovery of her arm and fingers on the affected side but also her rehabilitation goal of being able to cook again since a goal setting is important[2]. For risk management, the exercises were limited to those performed in a sitting position and her burden was confirmed before, during, and after the exercise. The exercise design was tentatively determined based on information from a manager of the nursing facility and from an interview with her. After that, the exercise load was adjusted according to her response in trial sessions by the occupational therapist. As a result of physical function measurements, questionnaires, and interviews, there was no improvement in physical functions, but an effect of her self-disclosure was confirmed.[1] Kitwood, T. and Bredin, K. (1992) Towards a theory of dementia care: Personhood and well-being, Ageing and Society, Vol.12, No.3, pp.269-287.[2] Smit EB, Bouwstra H, Hertogh CM, Wattel EM, van der Wouden JC. (2019) Goal-setting in geriatric rehabilitation: a systematic review and meta-analysis, Clin Rehabil., Vol.33, No.3, pp.395-407.