Discovery, Implementation, and Integration of Precision Rehabilitation Across the Lifespan

Hugo W. Moser Res Inst Kennedy Krieger, Baltimore MD

Investigators

Abstract

Project Summary (Research Project) Precision rehabilitation can improve rehabilitation medicine for heterogeneous clinical populations across the lifespan by delivering the right intervention, at the right time, in the right setting, to the right person. The Precise Center Research Project will demonstrate how the precision rehabilitation framework can be adopted via the fundamental stages of Discovery, Implementation, and Integration. The proposed three-stage framework draws on our extensive experience with developing feasible clinical and remote monitoring assessments, use of the multimodal data gathered for patient subgrouping, and integration of the heterogeneous data to develop precision rehabilitation algorithms for clinical practice. The Precise Center Research Project will also demonstrate how each of these stages can be executed to develop and advance the precision rehabilitation framework in clinical populations of young children, adolescents, and adults. The precision rehabilitation framework begins with the discovery of stakeholder needs. These stakeholders include clinicians, researchers, persons with lived experience, and families and caregivers. In Aim 1, the Precise Center Research Project will demonstrate the Discovery stage by conducting a thorough assessment of stakeholder needs in providing precision rehabilitation for children with cerebral palsy. This will include incorporation of patient, caregiver, and provider input to identify existing resources that can address identified needs. To address needs not met with existing resources, we will develop and validate a “motion capture in your pocket” automated motion analysis battery for more precise kinematic movement assessment in children with cerebral palsy that is informed directly by stakeholder input. Once needs have been identified, precision rehabilitation relies on implementing collection of granular, multimodal data at scale. In Aim 2, the Precise Center Research Project will demonstrate the Implementation stage by using wearable devices to collect granular physical activity and heart rate data from adolescents recovering from concussion. These remote monitoring data will be used to advance the precision rehabilitation framework by identifying clinically relevant patient subgroups that will facilitate more precise prescription of physical activity in adolescents with concussion. Multimodal data collection at scale then requires careful and comprehensive integration of these heterogeneous data sources in a centralized, interpretable system for data extraction and analyses. In Aim 3, the Precise Center Research Project will demonstrate the Integration stage by integrating multimodal data to uncover distinct subgroups of rehabilitation readiness and motor recovery in adults with stroke and elucidate how rehabilitation received moderates the transition from rehabilitation readiness to recovery trajectories using mixture modeling to develop precision rehabilitation algorithms. Finally, we will demonstrate how the longitudinal data and precision rehabilitation algorithms may be integrated into clinical care via the electronic health record.