Telerehabilitation with Computer Vision-Assisted Markerless Measures: A Pilot Study with Rett Syndrome Patients

Round 1

Reviewer 1 Report

This paper proposes Telerehabilitation with computer vision-assisted markerless 2 measures: a pilot study with Rett Syndrome patients, the research issues are hot issues, but the logic of the article is confused, there are a lot of formatting problems, the pictures are not clear, some specific problems are as follows:

Abstract:

The introduction of pre-test, post-test1 and post-test2 is too vague; It should not be generalized with "Results show significant improvements mostly in the upper limbs". IQR and RTT need to give their full names.

Introduction:

1. The introduction of Rett syndrome in this part is relatively detailed, but the development of the solution proposed by the author is not detailed enough.

2. Failure to list the innovations of the method proposed by the author.

Algorithm part:

1. The algorithm lacks innovation and specific description of the algorithm, such as the inferred trajectory of the bone model in the zed-openpose library and the mapping of the bone model from 2D to 3D.

2. The formula of the paper has less support, and the setting and calculation methods of variables are not given the reasons. For example, the sequence variable of formula (1).

3. The source and use method of the interactive interface between the patient and the therapist are not explained. Is it article construction? Use existing tools? The three data types obtained at the end of the treatment, such as JSON file and.webm file, are not given, and the communication method of storing the data to the cloud server is not given.

Experimental Part:

1. The paper lacks the algorithm comparison experiment, the author only sets the longitudinal experimental results comparison in this experimental stage, can it increase the comparison with the frontier algorithm, so as to show the effectiveness of this algorithm? It is recommended to increase the comparison test with other algorithms or systems.

2. The sample is relatively simple, and the participants are all female. Male and female individuals have obvious differences in bone structure, so the bone model speculated in this paper is not representative. Moreover, the range of joint angles is also different, and the experiment lacks robustness.

3. The experimental setting is relatively simple, and only statistical rules of Angle data are analyzed. It is suggested to analyze the experimental results from different angles.

Author Response

Please see the attachment

Reviewer 2 Report

The purpose of the manuscript is to propose a technique to evaluate and improve the shoulder, elbow, and knee RoM of people with RTT through an individualized physical therapy intervention that is remotely provided using the TCTRS system. The research is significant in the context of the COVID-19 scenario because patients with rare diseases require specialized centers and health professionals.  In my opinion, the manuscript is suitable for publication in the journal “Electronics” only after solving the mentioned major issues.

Major points:

1.      There have been several places in the manuscript where authors have directly copied from their already published materials.

Lines 27-41 were copied from https://www.tandfonline.com/doi/abs/10.1080/09638288.2021.1949398?journalCode=idre20

2.      In the abstract authors mentioned: “limitations due to costs or feasibility.” Which of these issues were solved or improved in the research? Authors need to say that too.

3.      Linesine from 62-72 were copied from another source. Even from their publications, authors should not use the direct copy version. Authors are suggested to use citations instead use the direct copy.  

4.      Several places show that “Error! References source not found.”. Please resolve those.

5.      The literature survey in line 84 related to “computer vision for clinical applications” is insufficient. Authors are suggested to provide a better and more extensive review of the recent and significant contributions.

6.      Linesine 97-99 are not the sufficient rationale behind the experiment. Authors must relate the earlier discussions in section 1 and justify the study aims.

7.      Lines 103-184 are directly copied from authors’ earlier publications. Also, the authors did not provide any citations against those copies. Table 1 was copied. Figures 1 and 2 too. The absence of sources of already published materials is unacceptable. Since the whole 2.1, 2.2, and 2.3 were taken from other printed materials, authors are suggested to use a citation, mention why they were the same, also significantly shorten those.

8.      Figure 3 needs to be in a higher resolution so that the numbers can be readable.

9.      Figure 4 needs to be in a higher resolution so that the text in the upper half can be readable.

10.   Authors should provide a flow diagram to explain the chronology “procedure” (subsection 2.5).

11.   What are the rationales behind the choice between lines 303-305?

12.   Authors need to discuss the limitations of their study in a section/subsection.

13.   Authors should not just state some statement from a reference (49) in the conclusion. Authors are suggested to discuss how and in which way their research supports/not supports the claim made by reference 49. 

Author Response

Please see the attachment

Author Response File: Author Response.docx

Reviewer 3 Report

I wish to thank the authors for contributing a well-designed study on a very important and timely research topic. 

Figures 1 and 2 should have higher resolution. Figure 2, why is the word Actors used? Should it say Participants instead of Actors? What does the SW mean in Tele-Rebab SW?

Line 66 and 92, references are missing. Overall, the references used to ground the study are excellent.

Line 206, the authors may want to discuss patient privacy and data security in the Cloud storage service.

I'm curious to know about the experiences of caregivers and therapists in this study. The authors might want to add 1-2 sentences to the Discussion Section to tell the reader if the caregivers and therapists recommend the rehabilitation program and why. 

The authors make a relevant and original contribution to knowledge in this preliminary study. I appreciate that the authors acknowledge the study's limitations and discuss their plans for future research.

Author Response

Please see the attachment

Reviewer 4 Report

The authors need to modify this paper to meet publication requirements. Here are some comments

1. The introduction needs to rewrite. The background information was too long. The authors need to introduce their main topic faster

2. The goals and background information was sufficient, but the readers cannot find the research and scientific questions that the authors wanted to answer.

3. Literature review needed to be included. How can the readers know if there was a similar research or system?

4. For the method, is a 21 sample size big enough for this research? 

5. What is your rubric for “the severity level range (5-20)”? Was there literature or standard?

6. The discussion was weak. This is because the authors needed a clear research question. The authors did analyze the data, but the readers need to figure out what to learn from the data.

7. Conclusion is not just a summarization. The authors must specify their scientific contributions, not just introduce a system.

Some format issues need to fix. For example, the reference numbers needed to be fixed. Figures are not clear and blurred.

Author Response

Please see the attachment

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Although the authors have addressed most questions，there are still some questions about the answers to the comments. The details are as follows:

1. For the question

"The literature survey in line 84 related to" computer vision for clinical applications "is insufficient Authors are suggested to provide a better and more extensive review of the recent and significant contributions.”

The content of the supplemented references has a high degree of overlap. The methods used in this manuscript are mainly based on Openpose and Kinect depth cameras to predict human joint points. The authors of these papers are basically same, and the cited references lack typicality. Moreover, the provided references are relatively old and do not provide the recent references.

2. For the question and the answer:

Authors should provide a flow diagram to explain the chronology "procedure" (subsection 2.5)

Response to the reviewer:

Thank you for this comment.  The Flow diagram is presented in Figure 1.  However, following your comment, a callout for Figure 1 was added in the 2.5 Procedure section to facilitate the reader.

Added text: “The procedure flow diagram is depicted in Figure 1. ”，

The "procedure" in the manuscript corresponds to section 2.4.

3. For the question "For the method, is a 21 sample size big enough for this research?", the authors cited the concept of Rett population sample size defined in the review "Caregiver - and Clinical Reported Adaptive Functioning in Rett Syndrome: a Systematic Review and Evaluation of Measurement Strategies.", which falls within the neuropsychological definition of the population. It cannot prove that the sample size in the system proposed by the authors is reasonable.

Author Response

Please find the attached document.

Author Response File: Author Response.pdf

Reviewer 2 Report

The authors have satisfactorily responded to all the queries and made substantial changes to their manuscript. It is recommended that the author check the whole manuscript for grammar and punctuation. 

Author Response

Thank you, we revised the text as suggested.

Reviewer 4 Report

Most questions were solved, and most comments were addressed.

Please pay attention to the second comment, "2. The goals and background information were sufficient, but the readers could not find the research and scientific question the authors wanted to answer."

The authors added objectives but still need to clarify the research questions at the beginning of the paper.

Author Response

Please find the attached document.

Author Response File: Author Response.pdf