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VA Maryland Health Care System


Health Watch Spring 2017

iVET Project Broadens the VA's Reach

Veteran patient using the iVET app on a tablet.For Franklin Gregg, 62, a stroke survivor, it takes the strength and determination of a Marine to stretch his body and perform specific exercises to stay limber. If he doesn't move enough, he said that he becomes too stiff and won't be able to move at all. Gregg, a Marine Veteran, finds himself doing some of the more subtle leg exercises that support balance while standing on his porch waiting for the MTA Mobility bus. "I do the exercises every day," he says.

Augustus "Gus" McMillan, 70, an Army Veteran, also exercises every day. Both Veterans aren't alone. Thanks to a clinical demonstration project referred to as the Interactive Video Exercise Tele-rehabilitation (iVET) program, Veterans like McMillian and Greg, can access personalized exercise workouts at home with a small portable computer called a tablet. Aided by a three-year, $258,000 grant from the VA Office of Rural Health, iVET aims to provide access to care by serving as a "virtual home therapist" to enhance oversight and safety to Veterans who want to become healthier or are struggling with physical deficits following a stroke. "Finding transportation to get to the medical center is difficult. This is especially difficult for stroke survivors or the elderly," said Dr. Charlene Hafer-Macko, a neurologist at the VA Maryland Health Care System. "The tablet enables Veterans to take their therapeutic exercises home with them, with coaching from the tablet. So, this allows us to broaden our reach."

To date, the VA Maryland Health Care System has distributed 48 tablets to Veterans in Baltimore and on the Eastern Shore. "You're focused on the person working along with you [in the video]. A human being, not a robot, and that means a lot," says Army Veteran Ronald Williams.

There is growing evidence that structured exercise can improve neuromotor function, cardio-metabolic health, and elements of cognitive function even years after a disabling stroke.

The task-oriented exercises, such as the side step, the squat, sitting and rising from a chair, among others, are loaded on the tablet and include aerobic and muscular endurance workouts to help Veterans focus on improving their gait, balance and cardio-metabolic health. The exercises are personalized to each Veteran's needs and are guided by exercise physiologists (known as "coaches") familiar to the Veteran. Also, the iVET tablets contain personalized education and nutrition modules that are also tailored to each Veteran and provide interactive learning that promotes health and wellness. "One of the most rewarding aspects of this program is that we can actually see people improving," says Alyssa Stookey, PhD, an exercise physiologist working on the project. "We can monitor the progress that Veterans make and adjust their exercise prescription accordingly. We can tell when they log in, and Veterans themselves can adjust the pace and intensity," she adds. "It's wonderful to see someone's quality of life improve from being more active."

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