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On the second day of the ACRM annual conference, I attended a session on the frontiers of wearable tech, expecting to hear about its exciting new possibilities for rehab delivery.
Wearable tech such as smart watches and fitness trackers could in theory help to increase rehabilitation capacity, by partially automating its delivery and reducing the proportion of therapist-led sessions, or by providing new capacity in locations with otherwise limited coverage.
The science is bewildering and impressive. The average smartphone apparently contains 17 in-built sensors, including an accelerometer and gyroscope tracking user movements. Similar measuring devices can now be embedded in clothing or even tattoos. Such data is therefore increasingly easy to collect, but it turns out that clinicians are struggling to figure out what to do with it, and that many everyday tasks use similar movements which makes the results difficult to interpret. Trials have been undertaken in relation to using smartphones for fall detection or therapy compliance, or wearable tech for gait and balance retraining, but without any transformational results yet. One speaker described it as ‘… a field trying to find itself’.
It seems that mainstream products are frequently still the technology of choice for many accident victims, because they are affordable, readily available, and do not carry the perceived stigma of disability equipment. Another ACRM session explored the adoption of smartphone apps and smart speakers such as Amazon Alexa or Google Home for rehabilitation of mild traumatic brain injury (mTBI) or PTSD symptoms.
The latest generation of apps includes problem-solving for mTBI patients (for example, the Brain in Hand app available in the UK) and an electronic relaxation breathing coach for calming mood in challenging situations. Smart speakers can support emotional regulation via environmental control of smart lights, music, or even scents (there is a smart air-freshener).
This tech proliferation is testing therapists, who find their patients presenting app lists for discussion, and who themselves need new skills and techniques for overcoming cognitive impairments when coaching effective tech adoption. On a practical level, patients may need to develop routines and strategies for recurring tech issues such as charging their devices, updating apps, or organising cloud storage.
In the serious injury claims environment, my impression is that wearable tech and portable devices currently offer more opportunities to claims handlers for investigation than perhaps they do to clinicians for rehab delivery. For example, I have recently defended cases where data from a cycling app was cross-referenced with conventional accident reconstruction to calculate approach speed, and where smartphone lifestyle information including travel photographs helped to disprove a seven-figure claim by a high-earner who alleged disabling fatigue.
The explosion of portable tech, and especially near-universal smartphone ownership and app usage, is radically changing society and, like in the medical sector, challenges us to design new working practices for serious injury claims in order to properly exploit the tech opportunities.
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