Quiddis Health and RUFFLE: the new frontier for the prevention of cognitive impairment

If the first Quiddis e-health project REACT was focused on rehabilitation, with RUFFLE, also carried out with the funding of Regione Lombardia and the European Community, the focus shifts to fragile subjects, aiming to build remote programs for the prevention and the slackening of cognitive impairment



The starting point for the realization of the RUFFLE project, “Remote StimUlation For FraIL PeoplE”, is undoubtedly represented by the results of the clinical trial of REACT, the first Quiddis project in the health sector for post-stroke rehabilitation, later extended to Parkinson‘s patients. 

The REACT experience, in fact, highlighted numerous indispensable improvements for the management of an effective relationship between medical professionals and patients, even at a distance. Firstly, the device chosen, in particular a tablet considered more suitable for the target due to its size and ease of use, was often not directly available to patients, undermining their participation in the program. Secondly, there was a need to create moments of direct discussion with patients, beyond the face-to-face meetings planned by the program. Finally, the user experience, especially for the patient, was lacking from the point of view of motivation and engagement, also due to actual difficulties in using the devices and accessing the contents. 

The first step for the implementation of RUFFLE, therefore, was an improvement, in terms of graphics and functionalities, of the platform used for the management and the execution of the exercises. Thus, Quiddis Health was born: an LMS platform adapted to the needs of e-health and equipped with an app specifically designed for patients, with integrated video call system and highly simplified user experience. 



Once the platform had been improved, the development of RUFFLE contents made use, as for the REACT project, of the support of Casa di Cura Privata del Policlinico medical staff.

The catalog consists of 218 exercises for slackening impairment and maintaining cognitive functions in patients either frail or in the initial phase of impairment. It allows to build customize programs based on various needs: the different levels of difficulty respond to different cognitive levels of patients, avoiding frustration and boredom caused by activities perceived as too difficult or too simple, while the ten types of exercises allow to train specific cognitive functions



Even more than with the previous project, in testing RUFFLE contents the use of the SCORM format, borrowed from e-learning world, proved to be invaluable. This, in fact, not only allowed the asynchronous assignment of exercises, leaving patients the freedom to perform them in the times and in the manner most congenial to them, but also allowed the therapist to access detailed reports containing various useful monitoring information. Time spent on the exercise, number of attempts made, answers to questions and final score obtained are just some of the data made available by the platform, in a graphical form that makes it easy to consult and use for the construction of customized programs. 

Even virtual appointments, organized independently by the therapists, are entirely tracked: it is possible to record the meeting – however making the registration accessible and available only to the patient, therapist and other specifically authorized subjects – and to know precisely the duration of the connection, in order to report the process precisely. 



The RUFFLE project was born with the aim of improving the lives of people who are frail or at risk of cognitive impairment, for physiological reasons or because in the early stages of degenerative diseases. Why focus on prevention and why do it at a distance

Surely, a first reason is to relieve the pressure on medical staff, often overworked, and let them free from carrying out activities that can be easily automated, thanks to an LMS platform such as Quiddis Health. In addition, the assignment of remote activities allows the patient to be engaged between the therapy sessions, giving continuity to the rehabilitation process and providing more information for ongoing assessment and the creation of tailor-made programs

On the patient side, however, the slackening of cognitive impairment allows those involved in the program to live a normal life as long as possible, remaining autonomous in carrying out the assigned exercises, but also and above all in ADL (Activities of Daily Living). Knowing that the patient is being followed promptly by an expert, even if from a distance, on the one hand increases motivation and adherence to therapy, helping patients to stay fit, and on the other hand makes patients more confident and helps them feel less alone in the process.


In the end, RUFFLE adds another brick to the Quiddis Health service, expanding its potential target and purpose of use. The next steps concern its distribution, both among medical staff and patients themselves, an aspect that is closely linked to prescription: the possibility of prescribing remote therapies would allow, as already mentioned, to increase efficiency and effectiveness of the prevention and rehabilitation, for the benefit of all the subjects involved. 

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