Interactive video exercise tele-rehabilitation (IVET) for stroke care in Jamaica

Stroke is a growing global public health issue in low and middle income countries, where prevalence rates for cerebrovascular events now exceed those in industrialized nations. Limited access to stroke rehabilitation, which includes prevention of physical inactivity and deconditioning to better manage risk factors for recurrent vascular events, remains a major barrier to care. In the Caribbean Community, this is compounded by population trends in aging and obesity that also require an integrative health education and nutrition program to manage the myriad metabolic risk factors that drive pan-vascular disease. To begin to address this gap, we developed Interactive Video Exercise Tele-rehabilitation (IVET) as a web-based and smart device linked technology to deliver personalized exercise rehabilitation, coupled as needed with nutrition and health education. The exercise program uses a pull down menu Avatar remotely manageable by a coach to personalize visual-motor reinforced mobility focused training, according to each individual's observed neurological and cardiopulmonary capacities. Rate and duration of exercise are adjusted to produce a measured aerobic intensity known to improve cardiovascular health. This initial report describes the IVET technology as a wireless tool for low and middle income countries, and demonstrates the exercise rehabilitation safety and performance profiles, and ratings for acceptance of the technology for 27 Jamaican adults with hemiparetic stroke.