Telerehabilitation Assessment Research Articles

Telerehabilitation Wheeled Mobility and Seating Assessments Compared With In Person

Schein RM, Schmeler MR, Holm MB, Saptono A, Brienza DM. Telerehabilitation wheeled mobility and seating assessments compared with in person. Objective To evaluate the equivalency of wheeled mobility and seating assessments delivered under 2 conditions: in person (IP) at a local clinic and via Telerehabilitation at remotely located clinics. Design The study used a prospective, multicenter controlled nonrandomized design to investigate wheeled mobility and seating assessments. Setting Five wheelchair clinics in Western Pennsylvania. Participants Participants (N=98) in need of new wheeled mobility and seating were recruited and consented for IP assessments at the Center for Assistive Technology (n=50) and Telerehabilitation (n=48) assessments at remotely located clinics. Interventions The telerehabilitation condition used a custom videoconferencing system to connect a wheeled mobility and seating expert at the University of Pittsburgh's Rehabilitation Engineering Research Center on Telerehabilitation to a remote clinic. Main Outcome Measures Study findings were based on the level of function the participants showed with their new wheeled mobility and seating devices as measured by using the Functioning Everyday with a Wheelchair (FEW) outcome tool. Results The results revealed no significant differences between the FEW pretest average or item scores for the 2 conditions or the FEW posttest average or item scores except for the FEW transportation item. The average FEW and FEW item scores reached the established clinically relevant pretest-posttest difference of 1.85, and the change scores were significantly different. The difference between FEW means based on posttest confidence intervals indicated that telerehabilitation was equally effective as IP rehabilitation. Conclusions An expert practitioner located at least 125 miles away from each of the remote sites used a secured videoconferencing system to consult from a geographic distance on wheeled mobility and seating evaluations via telerehabilitation. Compared with participants receiving standard IP care, the telerehabilitation treatment condition was equally effective on all but 1 outcome.

Interrater Agreement Between Telerehabilitation and Face-to-Face Clinical Outcome Measurements for Total Knee Arthroplasty

Outcome measures in physical therapy provide the basis for determining the patient's rehabilitation needs, developing an individual intervention plan, and reassessing the evolution of the condition after therapeutic intervention. Questions surrounding the validity and reliability of outcome measures obtained in the context of telerehabilitation remain. The goal of this study was to explore which outcome measures can be used reliably in the context of telerehabilitation after discharge from an acute care hospital for lower limb orthopedic surgery. Fifteen patients recently discharged after total knee arthroplasty were evaluated by two experienced therapists. Each therapist evaluated under a given condition (face-to-face assessment, telerehabilitation assessment) eight outcome measures taken from standard clinical tests routinely used in the management of orthopedic rehabilitation after total knee arthroplasty. Evaluations were measured at 1-day intervals. Telerehabilitation evaluations were conducted with a videoconference link (H.264 CoDecs with Pan, Tilt, Zoom cameras) between either the participant's home or a clinical environment and a remote clinical station over residential DSL lines at 512 kbps. Interrater agreement between the two measurement modes was analyzed using the Bland and Altman method and Kripendorff's alpha reliability estimate. The 95% confidence interval for mean difference between evaluation methods varied between -20% and 8% for knee range of motion measures, -85% and 55% for scar management, -33% and 29% for functional evaluations. Five out of the eight outcome measures showed reliability estimates of >0.80, with lowest reliability obtained for the scar assessment scale (0.34) and the highest reliability for the evaluation of the range of motion at the knee (0.87 in flexion and 0.85 in extension). Clinical variables typically measured in face-to-face evaluations can be measured successfully under telerehabilitation conditions with moderate reliability.

The Redesign and Re-evaluation of an Internet-Based Telerehabilitation System for the Assessment of Dysarthria in Adults

A previous study revealed that reliable assessment of dysarthria was feasible. However, that study also revealed a number of system limitations and suggested that technological enhancements and improvements in study design and clinical assessment protocols were needed before validity and reliability of assessment of dysarthria via telerehabilitation could be confirmed. In the current study, improvements in technology, study design, and clinical assessment protocols were implemented in order to re-examine the validity and reliability of assessing and diagnosing dysarthria via the telerehabilitation medium. The aim of this study was to explore the validity and reliability of assessing dysarthria using both formal standardized and informal assessments via a purpose-built telerehabilitation system. Twenty-four participants with an acquired dysarthria were assessed simultaneously via telerehabilitation and face-to-face (FTF) on a battery of assessments. A custom-built telerehabilitation system enabled real-time telerehabilitation assessment over a 128 Kbps Internet connection. Data analysis included an analysis of strength of agreement between the two methods using percentage agreement and weighted ? statistics. Inter-rater and intrarater reliability were also examined for both the FTF and telerehabilitation-led assessments. Good strength of agreement was found between the FTF and telerehabilitation assessment methods. High intrarater and inter-rater reliability within both the FTF and telerehabilitation assessment methods supported these findings. Participants reported high overall satisfaction in the telerehabilitatin environment. This study describes the improvements made to the telerehabilitation system reported previously and confirms that valid and reliable assessment of dysarthria using both standardized and informal assessments over the Internet is possible using this system.

Using telerehabilitation to assess apraxia of speech in adults

Telerehabilitation is the remote delivery of rehabilitation services via information technology and telecommunication systems. There have been a number of studies that have used videoconferencing to assess speech and language skills in people with acquired neurogenic communication disorders. However, few studies have focused on cases of apraxia of speech. In order to perform accurately differential diagnosis via the telerehabilitation medium, it is important that validation of the assessment of apraxia of speech be established as part of the overall evidence base for telerehabilitation communication assessment protocols. To determine if valid and reliable assessment of apraxia of speech using a standardized assessment tool was feasible via telerehabilitation. Eleven participants with an acquired apraxia of speech were assessed simultaneously via telerehabilitation and face-to-face methods on the Apraxia Battery for Adults - 2 (ABA-2). A custom-built telerehabilitation system developed at the University of Queensland enabled real-time telerehabilitation assessment over a 128 kbit/s internet connection. Data analysis included tests of significant difference between raw scores using the Wilcoxon signed rank statistic and analysis of the degree of agreement between the two methods using weighted Kappa statistics. Inter- and intra-rater reliabilities were also examined for the telerehabilitation-led assessments. Results revealed no significant differences between the subtest scores of the ABA-2 obtained in the telerehabilitation and face-to-face test environments (p = 0.06-0.68). Weighted Kappa statistics indicated moderate to very good agreement (0.59-1.00) between the two environments for the subtests of the ABA-2. The reliability study was hampered by small sample size; however, the data were suggestive of reasonable reliability. Participants reported high overall satisfaction, comfort level, and audio and visual quality in the telerehabilitation environment. The speech-language pathologists (SLP) reported some difficulties assessing participants with severe apraxia of speech via the telerehabilitation system. This study suggests that valid assessment of apraxia of speech using the ABA-2 over the internet is feasible. The reliability study on the telerehabilitation assessments was encouraging with results suggesting that telerehabilitation assessment using the ABA-2 could be reliable. Findings from the participant satisfaction questionnaire were favourable. However, comments from the SLP suggested that participants exhibiting severe apraxia of speech might be better suited to face-to-face assessment. These findings may have implications for the development of evidence-based guidelines for the use of telerehabilitation in the assessment of apraxia of speech. The authors propose that future research should include larger sample sizes with a range of participant severity levels and be conducted over higher bandwidth connections to explore further the validity and reliability of telerehabilitation assessment of apraxia of speech.

The effects of aphasia severity on the ability to assess language disorders via telerehabilitation

Background: Telerehabilitation is the remote delivery of rehabilitation services via information technology and telecommunication systems. There have been a number of recent studies that have used video conferencing to assess language skills in people with aphasia. These studies have highlighted the possibility that severity of impairment and aetiology may have an effect on the administration of telerehabilitation language assessment protocols. Furthermore, anecdotal accounts of difficulties in administering language assessment via telerehabilitation also demonstrate the need for research into the effects of severity of aphasia. It is important that the effects of severity of aphasia are determined as part of the overall evidence base for telerehabilitation language assessment protocols. Aims: To investigate the influence of severity of aphasia on the ability to assess acquired aphasia via telerehabilitation methods. Methods & Procedures: A total of 32 participants with an acquired aphasia were assessed simultaneously via telerehabilitation and face‐to‐face methods on the Boston Diagnostic Aphasia Examination 3rd Edition Short Form (BDAE‐3) and the Boston Naming Test (BNT) (2nd Edition Short Form). A custom‐built telerehabilitation system developed at the University of Queensland enabled real‐time telerehabilitation assessment over a 128 kbit/s Internet connection. Participants were grouped according to their severity level. Data analysis was conducted on the differences in scores from the two assessors. Outcomes & Results: Results revealed that severity of aphasia did not greatly influence the accuracy of the telerehabilitation assessment for the majority of the BDAE‐3 clusters. However, severity of aphasia appeared to affect the ability to assess naming and paraphasia via telerehabilitation methods. Post‐hoc analysis revealed that the scores given in the face‐to‐face and telerehabilitation environments were comparable within each severity level. Conclusions: Results suggest that severity of aphasia may influence the ability to assess some language parameters via telerehabilitation. Further research should use larger sample sizes to confirm these results and to refine the telerehabilitation technology to enable these parameters to be adequately assessed. Additionally, clinician satisfaction with telerehabilitation assessment should be qualitatively researched so as to widen clinician acceptance of this method.

Using Telerehabilitation to Identify Home Modification Needs

Teleconferencing technology has great potential for providing cost-effective in-home assessment for home modification services from anywhere to anyone in need. Despite its enormous potential, the use of this technology as a means to deliver these specific services had not been investigated. This project investigated the use of televideo technology to provide remote home assessment services to patients prior to discharge so that they could function as independently as possible in their own homes after being discharged from a specialty clinic. Specifically, an assessment protocol that could be implemented using video-conferencing technology was developed and feasibility of the remote assessment process was determined by validating it against the standard of practice, an in-home assessment by a home modifications specialist. Independent in-home and remote home assessments were completed by two occupational therapists who specialize in home modifications. The results were compared for agreement in identification of specific accessibility problems in and quantitative measurements of the home. The remote assessment correctly identified a total of 51 of the 59 problems (86.4%) identified by the in-home assessment and only identified five problems (8.9%) that were not identified by the on-site assessment. In addition, 54 of 60 (90%) of the quantitative measurements from the remote assessment matched those from the in-home assessment. Findings suggest that remote telerehabilitation assessments have the potential to enable specialists to diagnose potential accessibility problems in home environments and prescribe appropriate modifications regardless of the location of the client, home, or specialist.