Video-Based Functional Performance Assessment and Training Tool
Objectives
The goal of the current phase of the Functional Performance Assessment and Training (F-PAT) project is to enhance the early rehabilitation of people with cerebral vascular accident (CVA or stroke) through personalized, function-oriented, multimedia-based patient and caregiver training. The technical objective of F-PAT is to develop a simplified computer-based data and video-manipulation software tool to aid clinical professionals in the process of developing annotated, graphics-enhanced video. The clinical objective of F-PAT is to examine the effectiveness of a personalized home-use videotape, containing footage of the patient performing tasks incorrectly and correctly in the clinic, compared to current instructional materials.
Research Plan
In this phase, we are collaborating with clinicians at the Comprehensive Rehabilitation Center (CRC). Based on the current procedure for training people to do transfers, we have defined a standard set of transfer types for the F-PAT videotaping. The F-PAT technical staff will customize an application, based on commercial hardware and software, to perform data integration, videoclip cataloguing, and computer-based videoclip manipulation so that a final videotape, containing personalized information, overlaid graphics and spoken instruction, can be produced with little knowledge of video-editing techniques. Using three groups of test subjects, we will test whether this approach to training is more effective than current methods in increasing carryover and reducing patient and caregiver injury in the home setting.
Methods
Fifteen test subjects will be randomly divided into three groups and receive different educational materials on transfers at the time of discharge following their initial stroke therapy: Group 1 will receive the standard materials; Group 2 will receive the standard materials and a mass-produced videotape on transfer instruction; Group 3 will receive the standard materials plus the personalized F-PAT videotape of instruction.
During the standard one-month follow-up visit of the stroke patient, the staff physiatrist will perform a routine examination. The effectiveness of the training materials will be tested by asking the subject to perform the standard F-PAT set of transfer tasks. The clinical staff will perform a video analysis of the videoclips and rate subject performance compared to their performance one month earlier. Additional information that is part of the regular examination process (e.g., asking about problems with the home-based recovery, interpersonal issues, falls or back injuries sustained by caregivers) will also be used to assess the training material effectiveness.
Findings
A preliminary F-PAT has been designed to support functional outcome efficacy studies of treatment interventions using a multimedia approach. In collaboration with the PAVAHCS SCI Hand Clinic, a set of ten functional tasks was derived to demonstrate the effects of repetitive strain injury of persons with paraplegia who are manual wheelchair users. We have tested the hardware, software, and video equipment with three test subjects to validate the approach . We explored whether analysis of video segments of tasks can assist a clinician in preparing a treatment plan for the patient, sharing patient information with members of the multidisciplinary team, and creating and implementing a patient-specific home program. We determined that F-PAT could support many patient recovery tracking tasks that a therapist does on a daily basis.
A VA Pilot Proposal is currently being prepared for submission to extend the preliminary F-PAT concept to the patient education application described above. Our long term goal is to integrate the F-PAT module in clinical practice as one of the available assessment and training tools, with annotated, indexed videotape being the unique component F-PAT offers.